Intestinal stem cells and their defining niche.

PubMed

Tan, David Wei-Min; Barker, Nick

2014-01-01

The intestinal epithelium is a classic example of a rapidly self-renewing tissue fueled by dedicated resident stem cells. These stem cells reside at the crypt base, generating committed progeny that mature into the various functional epithelial lineages while following a rapid migratory path toward the villi. Two models of intestinal stem cell location were proposed half a century ago and data have been presented in support of both models, dividing the scientific community. Molecular markers have been identified and validated using new techniques such as in vivo lineage tracing and ex vivo organoid culture. The intestinal stem cell niche comprises both epithelial cells, in particular the Paneth cell, and the stromal compartment, where cell-associated ligands and soluble factors regulate stem cell behavior. This review highlights the recent advances in identifying and characterizing the intestinal stem cells and their defining niche. © 2014 Elsevier Inc. All rights reserved.

Enteric Virome Sensing—Its Role in Intestinal Homeostasis and Immunity

PubMed Central

Metzger, Rebecca N.; Krug, Anne B.; Eisenächer, Katharina

2018-01-01

Pattern recognition receptors (PRRs) sensing commensal microorganisms in the intestine induce tightly controlled tonic signaling in the intestinal mucosa, which is required to maintain intestinal barrier integrity and immune homeostasis. At the same time, PRR signaling pathways rapidly trigger the innate immune defense against invasive pathogens in the intestine. Intestinal epithelial cells and mononuclear phagocytes in the intestine and the gut-associated lymphoid tissues are critically involved in sensing components of the microbiome and regulating immune responses in the intestine to sustain immune tolerance against harmless antigens and to prevent inflammation. These processes have been mostly investigated in the context of the bacterial components of the microbiome so far. The impact of viruses residing in the intestine and the virus sensors, which are activated by these enteric viruses, on intestinal homeostasis and inflammation is just beginning to be unraveled. In this review, we will summarize recent findings indicating an important role of the enteric virome for intestinal homeostasis as well as pathology when the immune system fails to control the enteric virome. We will provide an overview of the virus sensors and signaling pathways, operative in the intestine and the mononuclear phagocyte subsets, which can sense viruses and shape the intestinal immune response. We will discuss how these might interact with resident enteric viruses directly or in context with the bacterial microbiome to affect intestinal homeostasis. PMID:29570694

Interplay between intestinal alkaline phosphatase, diet, gut microbes and immunity.

PubMed

Estaki, Mehrbod; DeCoffe, Daniella; Gibson, Deanna L

2014-11-14

Intestinal alkaline phosphatase (IAP) plays an essential role in intestinal homeostasis and health through interactions with the resident microbiota, diet and the gut. IAP's role in the intestine is to dephosphorylate toxic microbial ligands such as lipopolysaccharides, unmethylated cytosine-guanosine dinucleotides and flagellin as well as extracellular nucleotides such as uridine diphosphate. IAP's ability to detoxify these ligands is essential in protecting the host from sepsis during acute inflammation and chronic inflammatory conditions such as inflammatory bowel disease. Also important in these complications is IAP's ability to regulate the microbial ecosystem by forming a complex relationship between microbiota, diet and the intestinal mucosal surface. Evidence reveals that diet alters IAP expression and activity and this in turn can influence the gut microbiota and homeostasis. IAP's ability to maintain a healthy gastrointestinal tract has accelerated research on its potential use as a therapeutic agent against a multitude of diseases. Exogenous IAP has been shown to have beneficial effects when administered during ulcerative colitis, coronary bypass surgery and sepsis. There are currently a handful of human clinical trials underway investigating the effects of exogenous IAP during sepsis, rheumatoid arthritis and heart surgery. In light of these findings IAP has been marked as a novel agent to help treat a variety of other inflammatory and infectious diseases. The purpose of this review is to highlight the essential characteristics of IAP in protection and maintenance of intestinal homeostasis while addressing the intricate interplay between IAP, diet, microbiota and the intestinal epithelium.

The Effects of Density in a High-Rise Residence Hall on Helping Behavior and Social Interaction

ERIC Educational Resources Information Center

Stoner, Kenneth L.; Thurman, Christopher W.

1978-01-01

Focuses on the effects of high-density housing on the helping behaviors and social interactions of the residents living within such buildings. Concludes by recommending ways to overcome some of the negative effects of high-density housing. (Author)

Atopic dermatitis and the intestinal microbiota in humans and dogs.

PubMed

Craig, J Mark

2016-05-01

The prevalence of human and canine allergic diseases is commonly perceived to be increasing. Suggested predisposing factors in people and dogs include increased allergen load, increased exposure to pollutants, reduced family size, reduced microbial load and less exposure to infection at a young age, increasingly urbanised environment, and changes in dietary habits. Genetic make-up may provide a template for phenotypic predisposition which is strongly influenced by our diet and environment leading to constant regulation of gene expression. One way in which diet can alter gene expression is via its effects on the gut flora or microbiota, the collection of microbes residing in the gastrointestinal tract. The resident microbiota is important in maintaining structural and functional integrity of the gut and in immune system regulation. It is an important driver of host immunity, helps protect against invading enteropathogens, and provides nutritional benefits to the host. Disruption of the microbiota (dysbiosis) may lead to severe health problems, both in the gastrointestinal tract and extra-intestinal organ systems. The precise mechanisms by which the intestinal microbiota exerts its effects are only beginning to be unravelled but research is demonstrating close links between gut microflora and many factors involved in the pathogenesis of atopic dermatitis (AD). AD and indeed any other 'skin disease', may be seen as a possible manifestation of a more systemic problem involving gut dysbiosis and increased intestinal permeability, which may occur even in the absence of gastrointestinal signs. Manipulation of the canine intestinal microbiota as a method for modifying atopy, may be attempted in many ways including avoidance of certain foods, supplementation with probiotics and prebiotics, optimising nutrient intake, minimising stress, antimicrobial therapy, correction and prevention of low stomach acid, and faecal microbiota transplantation (FMT).

The Infant Intestinal Microbiome: Friend or Foe?

PubMed Central

Mshvildadze, Maka; Neu, Josef

2013-01-01

During the course of mammalian evolution there has been a close relationship between microbes residing in the gastrointestinal (GI) tract and the mammalian host. Interactions of resident intestinal microbes with the luminal contents and the mucosal surface play important roles in normal intestinal development, nutrition and adaptive innate immunity. The GI tract of the premature infant has a large but fragile surface area covered by a thin monolayer of epithelial cells that overlies a highly immunoreactive submucosa. Interactions in the lumen between microbes, nutrients and the intestinal mucosa can range from a healthy homeostasis to an uncontrolled systemic inflammatory response syndrome (SIRS) that leads to multiple organ system failure and death. Recent advances in molecular microbiota analytic methodology that stem from advances in high throughput sequencing technology have provided us with the tools to determine the GI microbiota in great depth, including the nearly 80 % of microbes in the intestine that are very difficult if not impossible to culture by current methodology. Application of these techniques to derive a better understanding of the developing intestinal ecosystem in the premature neonate may hold the key to understand and eventually prevent several important diseases including necrotizing enterocolitis (NEC) and late onset neonatal sepsis that may be acquired via translocation through the GI tract. PMID:20116944

Interplay between intestinal alkaline phosphatase, diet, gut microbes and immunity

PubMed Central

Estaki, Mehrbod; DeCoffe, Daniella; Gibson, Deanna L

2014-01-01

Intestinal alkaline phosphatase (IAP) plays an essential role in intestinal homeostasis and health through interactions with the resident microbiota, diet and the gut. IAP’s role in the intestine is to dephosphorylate toxic microbial ligands such as lipopolysaccharides, unmethylated cytosine-guanosine dinucleotides and flagellin as well as extracellular nucleotides such as uridine diphosphate. IAP’s ability to detoxify these ligands is essential in protecting the host from sepsis during acute inflammation and chronic inflammatory conditions such as inflammatory bowel disease. Also important in these complications is IAP’s ability to regulate the microbial ecosystem by forming a complex relationship between microbiota, diet and the intestinal mucosal surface. Evidence reveals that diet alters IAP expression and activity and this in turn can influence the gut microbiota and homeostasis. IAP’s ability to maintain a healthy gastrointestinal tract has accelerated research on its potential use as a therapeutic agent against a multitude of diseases. Exogenous IAP has been shown to have beneficial effects when administered during ulcerative colitis, coronary bypass surgery and sepsis. There are currently a handful of human clinical trials underway investigating the effects of exogenous IAP during sepsis, rheumatoid arthritis and heart surgery. In light of these findings IAP has been marked as a novel agent to help treat a variety of other inflammatory and infectious diseases. The purpose of this review is to highlight the essential characteristics of IAP in protection and maintenance of intestinal homeostasis while addressing the intricate interplay between IAP, diet, microbiota and the intestinal epithelium. PMID:25400448

[Intestinal parasitic diseases in children].

PubMed

Mare, Anca; Man, A; Toma, Felicia; Székely, Edit; Lôrinczi, Lilla; Sipoş, Anca

2007-01-01

To compare the incidence of intestinal parasitosis between children with residence in urban and rural areas: to compare the efficacy of parasitologic diagnostic methods. In our study we included two lots of children. The first lot consisted in 74 children from rural areas from which we collected 44 samples of feces and 55 samples for the "Scotch tape" test. The second lot consisted in 214 children from urban areas from which we collected 44 samples of feces. We examined each sample of feces by three different methods. The study was performed between April to June 2006. The incidence of intestinal parasitosis increases in children from urban areas towards rural areas, and in children between 5 and 10 years. Ascariasis is the most frequent disease in both urban and rural areas. By examination of each fecal sample by three different methods, the number of positive cases increased. The residence in rural areas and age between 5 to 10 years are risk factors for intestinal parasitosis. The "Scotch tape" test was more efficient in Enterobius vermicularis infection than the methods performed from feces. We recommend using at the same time three diagnostic methods for feces examination to improve the diagnostic sensibility.

Tolerance exists towards resident intestinal flora but is broken in active inflammatory bowel disease (IBD)

PubMed

Duchmann, R; Kaiser, I; Hermann, E; Mayet, W; Ewe, K; Meyer zum Büschenfelde, K H

1995-12-01

Hyporesponsiveness to a universe of bacterial and dietary antigens from the gut lumen is a hallmark of the intestinal immune system. Since hyperresponsiveness against these antigens might be associated with inflammation, we studied the immune response to the indigenous intestinal microflora in peripheral blood, inflamed and non-inflamed human intestine. Lamina propria monocuclear cells (LPMC) isolated from inflamed intestine but not peripheral blood mononuclear cells (PBMC) of IBD patients with active inflammatory disease strongly proliferated after co-culture with sonicates of bacteria from autologous intestine (BsA). Proliferation was inhibitable by anti-MHC class II MoAb, suggesting that it was driven by antigen. LPMC from adjacent non-inflamed intestinal areas of the same IBD patients and PBMC or LPMC isolated from non-inflamed intestine of controls and patients with IBD in remission, in contrast, did not proliferate. PBMC or LPMC which had been tolerant to bacteria from autologous intestine, however, strongly proliferated after co-culture with bacterial sonicates from heterologous intestine (BsH). This proliferation was associated with an expansion of CD8+ T cells, increased expression of activation markers on both CD4+ and CD8+ lymphocyte subsets, and production of IL-12, interferon-gamma (IFN-gamma), and IL-10 protein. These results show that tolerance selectively exists to intestinal flora from autologous but not heterologous intestine, and that tolerance is broken in intestinal inflammation. This may be an important mechanism for the perpetuation of chronic IBD.

Tolerance exists towards resident intestinal flora but is broken in active inflammatory bowel disease (IBD)

PubMed Central

Duchmann, R; Kaiser, I; Hermann, E; Mayet, W; Ewe, K; Meyer zum Büschenfelde, K H

1995-01-01

Hyporesponsiveness to a universe of bacterial and dietary antigens from the gut lumen is a hallmark of the intestinal immune system. Since hyperresponsiveness against these antigens might be associated with inflammation, we studied the immune response to the indigenous intestinal microflora in peripheral blood, inflamed and non-inflamed human intestine. Lamina propria monocuclear cells (LPMC) isolated from inflamed intestine but not peripheral blood mononuclear cells (PBMC) of IBD patients with active inflammatory disease strongly proliferated after co-culture with sonicates of bacteria from autologous intestine (BsA). Proliferation was inhibitable by anti-MHC class II MoAb, suggesting that it was driven by antigen. LPMC from adjacent non-inflamed intestinal areas of the same IBD patients and PBMC or LPMC isolated from non-inflamed intestine of controls and patients with IBD in remission, in contrast, did not proliferate. PBMC or LPMC which had been tolerant to bacteria from autologous intestine, however, strongly proliferated after co-culture with bacterial sonicates from heterologous intestine (BsH). This proliferation was associated with an expansion of CD8+ T cells, increased expression of activation markers on both CD4+ and CD8+ lymphocyte subsets, and production of IL-12, interferon-gamma (IFN-gamma), and IL-10 protein. These results show that tolerance selectively exists to intestinal flora from autologous but not heterologous intestine, and that tolerance is broken in intestinal inflammation. This may be an important mechanism for the perpetuation of chronic IBD. PMID:8536356

The intestine is a blender

NASA Astrophysics Data System (ADS)

Yang, Patricia; Lamarca, Morgan; Kravets, Victoria; Hu, David

According to the U.S. Department of Health and Human Services, digestive disease affects 60 to 70 million people and costs over 140 billion annually. Despite the significance of the gastrointestinal tract to human health, the physics of digestion remains poorly understood. In this study, we ask a simple question: what sets the frequency of intestinal contractions? We measure the frequency of intestinal contractions in rats, as a function of distance down the intestine. We find that intestines Contract radially ten times faster than longitudinally. This motion promotes mixing and, in turn, absorption of food products by the intestinal wall. We calculate viscous dissipation in the intestinal fluid to rationalize the relationship between frequency of intestinal contraction and the viscosity of the intestinal contents. Our findings may help to understand the evolution of the intestine as an ideal mixer.

The intestine is a blender

NASA Astrophysics Data System (ADS)

Yang, Patricia; Lamarca, Morgan; Hu, David

2015-11-01

According to the U.S. Department of Health and Human Services, digestive disease affects 60 to 70 million people and costs over 140 billion annually. Despite the significance of the gastrointestinal tract to human health, the physics of digestion remains poorly understood. In this study, we ask a simple question: what sets the frequency of intestinal contractions? We measure the frequency of intestinal contractions in rats, as a function of distance down the intestine. We find that intestines contract radially ten times faster than longitudinally. This motion promotes mixing and, in turn, absorption of food products by the intestinal wall. We calculate viscous dissipation in the intestinal fluid to rationalize the relationship between frequency of intestinal contraction and the viscosity of the intestinal contents. Our findings may help to understand the evolution of the intestine as an ideal mixer.

Inhibition of macrophage function prevents intestinal inflammation and postoperative ileus in rodents

PubMed Central

Wehner, Sven; Behrendt, Florian F; Lyutenski, Boris N; Lysson, Mariola; Bauer, Anthony J; Hirner, Andreas; Kalff, Jörg C

2007-01-01

Background Abdominal surgery results in a molecular and cellular inflammatory response in the intestine, leading to postoperative ileus. It was hypothesised that resident macrophages within the intestinal muscularis have an important role in this local inflammation. Aims To investigate whether chemical or genetic depletion of resident muscularis macrophages would lead to a reduction in the local inflammation and smooth‐muscle dysfunction. Methods Two rodent models were used to deplete and inactivate macrophages: (1) a rat model in which resident macrophages were depleted by chlodronate liposomes; (2) a model of mice with osteopetrosis mice, completely lacking the resident muscularis macrophages, used as an additional genetic approach. Animals with normal or altered intestinal macrophages underwent surgical intestinal manipulation. The inflammatory response was investigated by quantitative reverse transcriptase‐polymerase chain reaction for mRNA of MIP‐1α, interleukin (IL)1β, IL6, intracellular adhesion molecule 1 (ICAM‐1) and monocyte chemotractant protein 1 (MCP)‐1 in the isolated small bowel muscularis. In addition, muscularis whole mounts were used for histochemical and immunohistochemical analysis to quantify leucocyte infiltration and detect cytokine expression. Subsequently, in vitro muscle contractility and in vivo gastrointestinal transit were measured. Results Both models resulted in markedly decreased expression of MIP‐1α, IL1β, IL6, ICAM‐1 and MCP‐1 after manipulation compared with controls. In addition to this decrease in inflammatory mediators, recruitment of leucocytes into the muscularis was also diminished. Macrophage‐altered animals had near normal in vitro jejunal circular muscle function and gastrointestinal transit despite surgical manipulation. Conclusions Resident intestinal muscularis macrophages are initially involved in inflammatory responses resulting in postoperative ileus. Depletion and inactivation of the

Controlling the frontier: regulatory T-cells and intestinal homeostasis.

PubMed

Bollrath, Julia; Powrie, Fiona M

2013-11-30

The intestine represents one of the most challenging sites for the immune system as immune cells must be able to mount an efficient response to invading pathogens while tolerating the large number and diverse array of resident commensal bacteria. Foxp3(+) regulatory T-cells (Tregs) play a non-redundant role at maintaining this balance. At the same time Treg cell differentiation and function can be modulated by the intestinal microbiota. In this review, we will discuss effector mechanisms of Treg cells in the intestine and how these cells can be influenced by the intestinal microbiota. Copyright © 2013 Elsevier Ltd. All rights reserved.

Diagnosis and interpretation of intestinal dysbiosis in dogs and cats.

PubMed

Suchodolski, Jan S

2016-09-01

The intestinal tracts of dogs and cats harbor a highly complex microbiota, which consists of bacteria, fungi, viruses and protozoa. Until recently, traditional bacterial culture was commonly used to identify bacteria present in the gastrointestinal tract, but it is now well recognized that standard plating techniques do not have enough resolution for identification of the mostly anaerobic bacteria that reside within the gut. Molecular methods are now established for assessing intestinal dysbiosis in dogs and cats with gastrointestinal disease, but these approaches are not yet widely available for routine diagnosis. The loss of normal commensal bacterial microbiota (i.e. Lachnospiraceae, Ruminococcaceae, and Faecalibacterium spp.) in acute and chronic intestinal diseases has been linked to metabolic changes, for example alterations in immunomodulatory bacterial metabolites, such as short chain fatty acids and secondary bile acids. This highlights the importance of dysbiosis in the pathophysiology of gastrointestinal diseases. Development of molecular based assays for specific bacterial groups, calculations of microbial dysbiosis indices and assays for microbial functional metabolites are currently underway to help assess dysbiosis. These will yield a better understanding of the pathophysiology of gastrointestinal diseases and may also lead to new diagnostic and therapeutic approaches to dysbiosis. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Survey of infections of intestinal parasites and related factors in north-west Shandong Province].

PubMed

Xu, Yan; Miao, Feng; Kong, Xiang-Li; Wang, Yong-Bin; Bu, Xiu-Qin; Zhang, Ben-Guang; Zhao, Chang-Lei; Liu, Xin; Chen, Xi-Xin

2014-10-01

To understand the infection status of intestinal parasites and related knowledge and behavior factors of the residents in north-west Shandong Province, so as to provide the evidence for taking targeted preventive measures. Eighteen villages were randomly selected as survey spots by the stratified multi-stage sample method. The Kato-Katz technique was used to detect intestinal parasite eggs among the residents and the cellophane tape anus test was used to detect Enterobius vermicularis eggs among 3-12 years old children. Questionnaires were applied to investigate related knowledge and behavior factors about the intestinal parasite infections in the residents. Totally 6 366 residents were detected for intestinal parasites and the infection rate was 0.28% (18 cases). Totally 895 children were detected for E. vermicularis and the infection rate was 5.70% (51 cases). Totally 2 915 residents were investigated by questionnaires and the awareness rate of knowledge about preventing parasitic diseases was 26.72%. The formation rates of washing hands before meal and after WC, washing fruit and vegetable before eating, never drinking unboiled water were 55.42%, 42.87%, 43.54% and 83.04% respectively. The awareness rate of knowledge about preventing parasitic diseases of 3-12 years old children was 12.24%; and the formation rates of washing hands before meal and after WC were 47.04% and 30.44% respectively. The total infection rate of intestinal parasites is low but the E. vermicularis infection rate is high among children in north-west Shandong Province. The awareness rate of knowledge about preventing parasitic diseases and the formation rates of healthy behaviors are all low. Therefore, the targeted health education should be taken to increase the awareness rate and guide the residents to develop their healthy behaviors.

Development and maintenance of intestinal regulatory T cells.

PubMed

Tanoue, Takeshi; Atarashi, Koji; Honda, Kenya

2016-05-01

Gut-resident forkhead box P3 (FOXP3)(+)CD4(+) regulatory T cells (Treg cells) are distinct from those in other organs and have gut-specific phenotypes and functions. Whereas Treg cells in other organs have T cell receptors (TCRs) specific for self antigens, intestinal Treg cells have a distinct set of TCRs that are specific for intestinal antigens, and these cells have pivotal roles in the suppression of immune responses against harmless dietary antigens and commensal microorganisms. The differentiation, migration and maintenance of intestinal Treg cells are controlled by specific signals from the local environment. In particular, certain members of the microbiota continuously provide antigens and immunoregulatory small molecules that modulate intestinal Treg cells. Understanding the development and the maintenance of intestinal Treg cells provides important insights into disease-relevant host-microorganism interactions.

Getting by with a little help from friends and colleagues: Testing how residents' social support networks affect loneliness and burnout.

PubMed

Rogers, Eamonn; Polonijo, Andrea N; Carpiano, Richard M

2016-11-01

To determine how residents' relationships with their sources of social support (ie, family, friends, and colleagues) affect levels of burnout and loneliness. Cross-sectional survey. Faculty of Medicine at the University of British Columbia in Vancouver. A total of 198 physician-trainees in the university's postgraduate medical education program. Residents' personal and work-related burnout scores (measured using items from the Copenhagen Burnout Inventory); loneliness (measured using a 3-item loneliness scale); and social support (assessed with the Lubben Social Network Scale, version 6). Of the 234 respondents who completed the Internet-based survey (a 22% response rate), 198 provided complete information on all study variables and thus constituted the analytic sample. Seemingly unrelated regression analyses indicated that loneliness was significantly ( P < .01) and positively associated with both personal and work-related burnout scores. Greater friend-based and colleague-based social support were both indirectly associated with lower personal and work-related burnout scores through their negative associations with loneliness. Social relationships might help residents mitigate the deleterious effects of burnout. By promoting interventions that stabilize and nurture social relationships, hospitals and universities can potentially help promote resident resilience and well-being and, in turn, improve patient care. Copyright© the College of Family Physicians of Canada.

Psychiatric Emergency Services - Can Duty-Hour Changes Help Residents and Patients?

PubMed

Brainch, Navjot; Schule, Patrick; Laurel, Faith; Bodic, Maria; Jacob, Theresa

2018-04-14

Limitations on resident duty hours have been widely introduced with the intention of decreasing resident fatigue and improving patient outcomes. While there is evidence of improvement in resident well-being and education following such initiatives, they have inadvertently resulted in increased number of hand-offs between clinicians leading to potential errors in patient care. Current literature emphasizes need for more specialty/setting-specific scheduling, while considering residents' opinions when implementing duty-hour reforms. There are no reports examining the impact of duty-hour changes on residents or patients in psychiatric emergency service (PES) settings. Our purpose was to assess the impact of a recent scheduling change and decrease in overall duty hours, on resident well-being and sense of burnout, while also evaluating changes to patient wait-time and length of stay (LOS) in PES. Residents completed Maslach Burnout Inventory and anonymous surveys focusing on: fatigue, sleep, life outside work for shifts - regular (8 am-8 pm) and swing shifts (12 pm-10 pm). Data from the electronic medical records were collected for 6 months pre- and post-schedule change (January 2016-February 2017), for LOS and patient wait-time. Residents' preference for shifts was split. However, 86% reported getting enough sleep during swing shifts, while 83% reported lack of sleep during regular shifts. The average patient wait-time and LOS significantly decreased from 169 to 147 and 690 to 515 min, respectively. The change to swing shifts significantly impacts LOS and patient wait-time. The short shifts demonstrated an improvement in well-being for residents, but were not the singular factor for overall resident satisfaction.

Improving surgical resident's performance in the American Board of Surgery in Training Examination (ABSITE)--do review courses help? The program directors' perspective.

PubMed

Taggarshe, Deepa; Mittal, Vijay

2011-01-01

The implementation of the 80-hour week compounded by the need for the current trainee to be well versed technically with the newer developments in surgery has resulted in limited time for didactic education. Commercial American Board of Surgery in Training examination (ABSITE) review courses are flourishing and may seem to be filling the gap in didactic education. This study ascertained the opinion of the general surgery program directors across the country on the role of the review courses in the ABSITE performance of a surgical resident. A questionnaire was designed and sent out to all program directors using online survey. Sixty-five of 242 program directors completed the questionnaire. Fifty-seven percent belonged to university-based surgical residency programs. Seventy-two percent used ABSITE performance as a measure while evaluating the resident for promotion. Although 60% agreed that review courses help the performance of the residents, 80% did not have any institutional or regional review courses. Ninety percent allowed their residents to attend commercial review courses but 60% did not reimburse them. Program directors do feel that ABSITE by itself is important in evaluating the progression of surgical residents and has a correlation with the boards' pass percentile. Due to the limited hours available for didactics in current surgical residency, intensive review course over a 2- to 3-day period may help the surgical residents to perform better. In the current economy, review courses offered by a consortium of programs geared toward improving ABSITE performance and conducted by the surgical faculty may be of essence. Copyright © 2011 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Inhibition of intestinal tumors by curcumin is associated with changes in the intestinal immune cell profile.

PubMed

Churchill, M; Chadburn, A; Bilinski, R T; Bertagnolli, M M

2000-04-01

The C57BL/6J-Min/+ (Min/+) mouse bears a germline mutation in Apc and is therefore a model for familial adenomatous polyposis and sporadic colorectal cancer. Min/+ intestinal mucosa exhibits a marked tendency for spontaneous adenoma formation. Curcumin is a phenolic antioxidant known for its antitumor and immune modulatory functions in vitro. Curcumin prevents adenoma formation in Min/+ mice, through a mechanism that may be related to its immunomodulatory properties. To study the relationship between intestinal immunity and curcumin-induced antitumor response, we used immunohistochemistry to characterize the effect of curcumin treatment on resident intestinal immune effector cells in Min/+ mice. These results show that mucosal CD4(+) T cells and B cells increase in animals treated with curcumin, suggesting that curcumin modulates lymphocyte-mediated immune functions. Copyright 2000 Academic Press.

Residency training in aesthetic surgery: maximizing the residents' experience.

PubMed

Stadelmann, W K; Rapaport, D P; Payne, W; Shons, A R; Krizek, T J

1998-06-01

Plastic surgery residency programs often rely on a residents' aesthetic clinic to help train residents in aesthetic surgery. The television media may be used to help boost interest in such clinics. We report our experience with a local television station in helping to produce a "health segment" broadcast that chronicled the experience of an aesthetic patient in the residents' aesthetic clinic. As a result of this broadcast, approximately 150 people responded by telephone and subsequently attended a series of seminars designed to screen patients and educate the audience about the aesthetic clinic. A total of 121 patients (112 women and 9 men) signed up for personal consultations. The age distribution and requested procedures are presented. From the data, we conclude that there is a healthy demand for reduced-fee plastic surgery procedures performed by residents in plastic surgery. The number and variety of cases generated are sufficiently diverse to provide a well-rounded operative experience. The pursuit of media coverage of a not-for-profit clinic has the potential for generating large patient volume. Such efforts, although very attractive, are not without their own risks, which must be taken into consideration before engaging the media in the public interest arena.

Cinema in the training of psychiatry residents: focus on helping relationships.

PubMed

Gramaglia, Carla; Jona, Amalia; Imperatori, Fredrica; Torre, Eugenio; Zeppegno, Patrizia

2013-06-21

Medical schools are currently charged with a lack of education as far as empathic/relational skills and the meaning of being a health-care provider are concerned, thus leading to increased interest in medical humanities. Medical humanities can offer an insight into human illness and in a broader outlook into human condition, understanding of one self, responsibility. An empathic relation to patients might be fostered by a matching approach to humanities and sciences, which should be considered as subjects of equal relevance, complementary to one another. Recently, movies have been used in medical--psychiatric--trainees education, but mainly within the limits of teaching a variety of disorders. A different approach dealing with the use of cinema in the training of psychiatry residents is proposed, based on Jung and Hillman's considerations about the relation between images and archetypes, archetypal experience and learning. Selected full-length movies or clips can offer a priceless opportunity to face with the meaning of being involved in a care-providing, helping profession.

Obstetrics and gynaecology chief resident attitudes toward teaching junior residents under normal working conditions.

PubMed

Gil, Karen M; Savitski, Jennifer L; Bazan, Sara; Patterson, Laurene R; Kirven, Melissa

2009-09-01

This study aimed to identify factors that chief residents believe impact the teaching of junior residents under normal working conditions and the areas in which they believe education on the role of resident as teacher would be beneficial. Obstetrics and gynaecology (O&G) chief residents were asked to rate the importance of teaching various skills, how often conflict situations arose, and to identify training that would be helpful through a national web-based survey. An e-mail was sent to coordinators of the Residency Review Committee (RRC) O&G residency programmes with a request that they forward the link to their chief residents three times from January through March 2006. Responses were received from 204 postgraduate Year 4 (PGY4) residents (18% of all PGY4 residents) from 133 programmes (54% of all residency programmes) and 33 states. Teaching junior residents how to prioritise patient care and obtain critical information in an emergent situation was considered very to extremely important by 97%. Conflict situations with junior residents were reported to occur between one and five times by 41-58%; an additional 26-28% reported that these situations occurred six or more times. Residents felt it would be helpful to extremely helpful to have training in resolving conflicts that involved patient care (48-59%), as well as in resolving conflict among junior residents, communicating effectively with them and becoming an effective leader (65-78%). The skills that chief residents considered most important to teach junior residents involved direct patient care. Chief residents would like training in how to resolve conflict with, and among, junior residents, and in how to become an effective leader.

The importance of appropriate initial bacterial colonization of the intestine in newborn, child and adult health

PubMed Central

Walker, W. Allan

2017-01-01

The fetus does not reside in a sterile intrauterine environment and is exposed to commensal bacteria from the maternal gut/blood stream which crosses the placenta and enters the amniotic fluid. This intestinal exposure to colonizing bacteria continues at birth and during the first year of life and has a profound influence on lifelong health. Why is this important? Intestinal crosstalk with colonizing bacteria in the developing intestine affects the infant’s adaptation to extrauterine life (immune homeostasis) and provides protection against disease expression (allergy, autoimmune disease, obesity, etc.) later in life. Colonizing intestinal bacteria are critical to the normal development of host defense. Disrupted colonization (dysbiosis) due to maternal dysbiosis, cesarean section delivery, use of perinatal antibiotics or premature delivery may adversely affect gut development of host defense and predispose to inflammation rather than homeostasis leading to increased susceptibility to disease later in life. Babies born by cesarean section have a higher incidence of allergy, type 1 diabetes and obesity. Infants given repeated antibiotic regimens during the first year of life are more likely to have asthma as adolescents. This research breakthrough helps to explain the shift in disease paradigms from infections to immune mediated in children from developed countries. This review will develop this research breakthrough. PMID:28426649

[Effect of control program of human intestinal parasitic diseases in Nanping City].

PubMed

Ming-Ying, Zhuo; Zhi-Ping, Zhang; Hong-Mei, Zhu; Hui, Zhang; Jia-Mei, Huang; Hui, Wen; Han-Guo, Xie

2016-01-22

To understand the epidemic status of human intestinal parasitic diseases and evaluate the effect of the control program in Nanping City, so as to provide an evidence for improving the disease control. The villages were selected by the stratified cluster sampling method and the residents in these villages were surveyed for human intestinal parasitic diseases, and kindergartens were also selected and the children in these kindergartens were surveyed for Enterobius vermicularis infection. In 2007, before the control program, 9 851 residents of Nanping City were surveyed, with the parasitic infection rate of 9.10% (896 infection cases), and the infection rate of E. vermicularis of children was 18.56% (328/1 767). From 2011 to 2014, when the control program was performed, 4 679 residents were surveyed, with the infection rate of 4.06% (190 infection cases), and the infection rate of E. vermicularis of children was 3.87% (33/853). After the control program was launched, the infection rates of human intestinal parasites were decreased. The overall parasitic infection rate and hookworm infection rate showed increasing trends by age ( χ 2 = 49.03 and 53.58 respectively, both P < 0.01). The infection situation of human intestinal parasites is decreased after the implementation of the control program but the infection rate is still at a high level, and the control work should be strengthened.

[Intestinal parasitosis among non-permanent resident students in Tunisia: a review of 23 years of monitoring in the department of Parasitology-Mycology at the Rabta Hospital of Tunisia].

PubMed

Dridi, Kalthoum; Fakhfakh, Najla; Belhadj, Sleh; Kaouech, Emira; Kallel, Kalthoum; Chaker, Emna

2015-07-01

In order to fight digestive parasitism in Tunisia, a national program of surveillance of non-permanent resident students in Tunisia has been found to detect these parasitosis in this target population. To determine the prevalence of intestinal parasitosis among non-permanent resident students in Tunisia, to identify the different parasitic species founded and to show the interest of this screening. During a period of 23 years (1990-2012), 7386 parasitological examinations of stools has been made among students essentially from or had visited tropical Africa, Maghreb and Middle-East, at the laboratory of Parasitology-Mycology at the Rabta Hospital of Tunis. The prevalence of intestinal parasitism found was 34.45% (i.e. 2545 infested students). Among the protozoa that have been isolated in the majority of cases (78.75%), amoebae were most frequently found (86.4%) represented mainly by Entamoeba coli and Endolimax nanus in respectively, 25.62 and 23.33% of parasites isolated; while Entamoeba histolytica/dispar, only pathogenic Amoeba was found in 8.05% of the total of parasites isolated. Regarding helminths, found in 21.25% of parasites isolated, Ankylostome was predominant (34.5%) represented by the species of Necator americanus. A single case of Ancylostom duodenale has been isolated. Among the identified parasite species, 38.7% were known parasitic pathogens for humans. These results note the interest of the control of the non-permanent resident students in Tunisia. The precocious tracking and treatment of affected subjects permits to avoid the introduction and the dissemination of parasites already rare and virulent strains in our country.

Functional foods and paediatric gastro-intestinal health and disease.

PubMed

Taylor, C J; Mahenthiralingam, E

2006-06-01

The application of molecular methods to gastro-intestinal diseases is giving insight into the way in which the resident intestinal microbiota interacts with the mucosal immune system. Using traditional culture techniques, the importance of mucosally-associated bacterial biofilms in maintaining mucosal integrity has been demonstrated in ways previously impossible. Changes in the balance of organisms at initiation of and during disease provide a rationale for interventions with functional foods which facilitate re-establishment of the homeostasis of healthy gut.

Resident dashboards: helping your clinical competency committee visualize trainees' key performance indicators.

PubMed

Friedman, Karen A; Raimo, John; Spielmann, Kelly; Chaudhry, Saima

2016-01-01

Under the Next Accreditation System, programs need to find ways to collect and assess meaningful reportable information on its residents to assist the program director regarding resident milestone progression. This paper discusses the process that one large Internal Medicine Residency Program used to provide both quantitative and qualitative data to its clinical competency committee (CCC) through the creation of a resident dashboard. Program leadership at a large university-based program developed four new end of rotation evaluations based on the American Board of Internal Medicine (ABIM) and Accreditation Council of Graduated Medical Education's (ACGME) 22 reportable milestones. A resident dashboard was then created to pull together both milestone- and non-milestone-based quantitative data and qualitative data compiled from faculty, nurses, peers, staff, and patients. Dashboards were distributed to the members of the CCC in preparation for the semiannual CCC meeting. CCC members adjudicated quantitative and qualitative data to present their cohort of residents at the CCC meeting. Based on the committee's response, evaluation scores remained the same or were adjusted. Final milestone scores were then entered into the accreditation data system (ADS) on the ACGME website. The process of resident assessment is complex and should comprise both quantitative and qualitative data. The dashboard is a valuable tool for program leadership to use both when evaluating house staff on a semiannual basis at the CCC and to the resident in person.

Cinema in the training of psychiatry residents: focus on helping relationships

PubMed Central

2013-01-01

Background Medical schools are currently charged with a lack of education as far as empathic/relational skills and the meaning of being a health-care provider are concerned, thus leading to increased interest in medical humanities. Discussion Medical humanities can offer an insight into human illness and in a broader outlook into human condition, understanding of one self, responsibility. An empathic relation to patients might be fostered by a matching approach to humanities and sciences, which should be considered as subjects of equal relevance, complementary to one another. Recently, movies have been used in medical – especially psychiatric - trainees education, but mainly within the limits of teaching a variety of disorders. A different approach dealing with the use of cinema in the training of psychiatry residents is proposed, based on Jung and Hillman’s considerations about the relation between images and archetypes, archetypal experience and learning. Summary Selected full-length movies or clips can offer a priceless opportunity to face with the meaning of being involved in a care-providing, helping profession. PMID:23800186

Resident dashboards: helping your clinical competency committee visualize trainees' key performance indicators.

PubMed

Friedman, Karen A; Raimo, John; Spielmann, Kelly; Chaudhry, Saima

2016-01-01

Introduction Under the Next Accreditation System, programs need to find ways to collect and assess meaningful reportable information on its residents to assist the program director regarding resident milestone progression. This paper discusses the process that one large Internal Medicine Residency Program used to provide both quantitative and qualitative data to its clinical competency committee (CCC) through the creation of a resident dashboard. Methods Program leadership at a large university-based program developed four new end of rotation evaluations based on the American Board of Internal Medicine (ABIM) and Accreditation Council of Graduated Medical Education's (ACGME) 22 reportable milestones. A resident dashboard was then created to pull together both milestone- and non-milestone-based quantitative data and qualitative data compiled from faculty, nurses, peers, staff, and patients. Results Dashboards were distributed to the members of the CCC in preparation for the semiannual CCC meeting. CCC members adjudicated quantitative and qualitative data to present their cohort of residents at the CCC meeting. Based on the committee's response, evaluation scores remained the same or were adjusted. Final milestone scores were then entered into the accreditation data system (ADS) on the ACGME website. Conclusions The process of resident assessment is complex and should comprise both quantitative and qualitative data. The dashboard is a valuable tool for program leadership to use both when evaluating house staff on a semiannual basis at the CCC and to the resident in person.

Present Status of Subclinical Intestinal Malabsorption in the Tropics

PubMed Central

Falaiye, J. M.

1971-01-01

A review of the literature on subclinical intestinal disease shows its probable relevance in certain nutritional deficiencies in the indigenous residents of tropical climates. A significant incidence of intestinal disease has been defined among asymptomatic fit-looking adult Nigerians. The results of subsequent investigation into the pathogenesis of this disorder strongly point to hypoalbuminaemia as the important factor capable of producing a biochemically and histologically defined malabsorptive state leading to subnormal nutritional status among members of this community. ImagesFIG. 3 PMID:5125280

Intestinal lymphangiectasia associated with recurrence of histiocytosis X.

PubMed

Hui, C K

2011-09-01

Intestinal lymphangiectasia may occur as a primary congenital disorder or a secondary disorder. Secondary lymphangiectasia could be associated with diseases such as abdominal carcinoma, retroperitoneal fibrosis or chronic pancreatitis. This is the first reported case of intestinal lymphangiectasia associated with recurrent histiocytosis X. This case report illustrates the need for more prospective, well-designed studies to determine the natural history and outcome of intestinal lymphangiectasia in the duodenum. Hopefully, these studies will also help clinicians identify which group of patients with intestinal lymphangiectasia in the duodenum is more likely to have a secondary cause.

[Epidemiology aspects intestinal parasitosis among the population of Baku].

PubMed

Khalafli, Kh N

2009-03-01

The aim of this study was to determine the prevalence of intestinal parasitosis in Baku and to evaluate its association with socio-economic and environmental factors. In the research 424 residents of Baku were investigated. Intestinal helminths and protozoosis were revealed by means of Standard methods of investigation (A.A.Turdiev (1967), K.Kato, M.Miura (1954) and C.Graham (1941) in modification variants R.E.Cobanov et al. (1993)). Data were analyzed using Student's t criterion and Van der Varden's X criterion. Total cases of infectious-contagious disease was about of 42,5+/-2,4% of investigated persons; ascaris, trichocephalus, trichostrongylus was found in 19,1+/-1,9% (p>0,001). There were some persons infected with Taeniarhynchus saginatus (mainly women)- 0,9+/-0,4% (p>0,001). In children the frequency of accompanying diseases was 2,15-4,3 times (X=5,19, p<0,01) higher than, among the adults. It is well known that parasitic diseases are more common in communities with low socio economic conditions. Socio-economic factors associated with intestinal parasites among residents were investigated. The investigation showed that the current socio economic conditions have caused the increase of intestinal parasitosis. If left untreated, serious complications may occur due to parasitic infections. Therefore, public health care employee as well as the officers of municipality and government should cooperate to improve the conditions, and also people should be informed about the signs, symptoms and prevention methods of the parasitic diseases.

Facebook Use between College Resident Advisors' and Their Residents: A Mixed Methods Approach.

PubMed

Kacvinsky, Lauren E; Moreno, Megan A

2014-01-01

Facebook use is nearly ubiquitous among college students. Studies have shown links between Facebook displays of depression or problem drinking and risk of these problems. This project aimed to determine whether Facebook could be used to help Resident Advisors (RAs) identify college students at risk for depression or problem drinking. Interviews were conducted with college freshmen to investigate whether they were Facebook "friends" with their RA. Focus groups were conducted with RAs to determine their views on Facebook friending their dormitory residents and using Facebook to help identify at-risk students. 72 freshmen were interviewed and 25 RAs participated in focus groups; both agreed it is common for RAs and residents to be Facebook friends. RAs commonly noted references to depression and problem drinking on residents' Facebook pages, which often led to in-person discussions with the resident. This study provides support that RAs use Facebook to identify issues that may impact their student residents. RAs emphasized benefits of in-person interactions in order to provide support and obtain additional details about the situation. Universities could consider whether providing RA education about Facebook interactions with residents merits encouragement within their existing RA training programs.

Structural and immunomodulatory differences among lactobacilli exopolysaccharides isolated from intestines of mice with experimentally induced inflammatory bowel disease.

PubMed

Górska, Sabina; Sandstrőm, Corine; Wojas-Turek, Justyna; Rossowska, Joanna; Pajtasz-Piasecka, Elżbieta; Brzozowska, Ewa; Gamian, Andrzej

2016-11-21

Characteristic changes in the microbiota biostructure and a decreased tolerance to intestinal bacteria have been associated with inflammatory bowel disease (IBD). However, few studies have examined the constituents of the intestinal microbiota, including the surface molecules of the bacteria, in healthy and IBD subsets. Here, we compare the chemical structures and immunomodulatory properties of the exopolysaccharides (EPS) of lactobacilli isolated from mice with induced IBD (IBD "+") versus those of healthy mice (IBD "-"). Classical structural analyses were performed using nuclear magnetic resonance spectroscopy and mass spectrometry. Immunomodulatory properties were assessed by stimulation of dendritic cells derived from mouse bone marrow or human peripheral mononuclear blood cells. Our results revealed that EPS produced by IBD "+" species are structurally different from those isolated from IBD "-". Moreover, the structurally different EPS generate different immune responses by dendritic cells. We speculate that resident strains could, upon gut inflammation, switch to producing EPS with specific motifs that are absent from lactobacilli IBD "-", and/or that bacteria with a particular EPS structure might inhabit the inflamed intestinal mucosa. This study may shed light on the role of EPS in IBD and help the development of a specific probiotic therapy for this disease.

Do resident's leadership skills relate to ratings of technical skill?

PubMed

Gannon, Samantha J; Law, Katherine E; Ray, Rebecca D; Nathwani, Jay N; DiMarco, Shannon M; D'Angelo, Anne-Lise D; Pugh, Carla M

2016-12-01

This study sought to compare general surgery research residents' survey information regarding self-efficacy ratings to their observed performance during a simulated small bowel repair. Their observed performance ratings were based on their leadership skills in directing their assistant. Participants were given 15 min to perform a bowel repair using bovine intestines with standardized injuries. Operative assistants were assigned to help assist with the repair. Before the procedure, participants were asked to rate their expected skills decay, task difficulty, and confidence in addressing the small bowel injury. Interactions were coded to identify the number of instructions given by the participants to the assistant during the repair. Statistical analyses assessed the relationship between the number of directional instructions and participants' perceptions self-efficacy measures. Directional instructions were defined as any dialog by the participant who guided the assistant to perform an action. Thirty-six residents (58.3% female) participated in the study. Participants who rated lower levels of decay in their intraoperative decision-making and small bowel repair skills were noted to use their assistant more by giving more instructions. Similarly, a higher number of instructions correlated with lower perceived difficulty in selecting the correct suture, suture pattern, and completing the entire surgical task. General surgery research residents' intraoperative leadership skills showed significant correlations to their perceptions of skill decay and task difficulty during a bowel repair. Evaluating resident's directional instructions may provide an additional individualized intraoperative assessment metric. Further evaluation relating to operative performance outcomes is warranted. Copyright © 2016 Elsevier Inc. All rights reserved.

Intestinal volvulus in cetaceans.

PubMed

Begeman, L; St Leger, J A; Blyde, D J; Jauniaux, T P; Lair, S; Lovewell, G; Raverty, S; Seibel, H; Siebert, U; Staggs, S L; Martelli, P; Keesler, R I

2013-07-01

Intestinal volvulus was recognized as the cause of death in 18 cetaceans, including 8 species of toothed whales (suborder Odontoceti). Cases originated from 11 institutions from around the world and included both captive (n = 9) and free-ranging (n = 9) animals. When the clinical history was available (n = 9), animals consistently demonstrated acute dullness 1 to 5 days prior to death. In 3 of these animals (33%), there was a history of chronic gastrointestinal illness. The pathological findings were similar to those described in other animal species and humans, and consisted of intestinal volvulus and a well-demarcated segment of distended, congested, and edematous intestine with gas and bloody fluid contents. Associated lesions included congested and edematous mesentery and mesenteric lymph nodes, and often serofibrinous or hemorrhagic abdominal effusion. The volvulus involved the cranial part of the intestines in 85% (11 of 13). Potential predisposing causes were recognized in most cases (13 of 18, 72%) but were variable. Further studies investigating predisposing factors are necessary to help prevent occurrence and enhance early clinical diagnosis and management of the condition.

Microbiota-dependent crosstalk between macrophages and ILC3 promotes intestinal homeostasis.

PubMed

Mortha, Arthur; Chudnovskiy, Aleksey; Hashimoto, Daigo; Bogunovic, Milena; Spencer, Sean P; Belkaid, Yasmine; Merad, Miriam

2014-03-28

The intestinal microbiota and tissue-resident myeloid cells promote immune responses that maintain intestinal homeostasis in the host. However, the cellular cues that translate microbial signals into intestinal homeostasis remain unclear. Here, we show that deficient granulocyte-macrophage colony-stimulating factor (GM-CSF) production altered mononuclear phagocyte effector functions and led to reduced regulatory T cell (T(reg)) numbers and impaired oral tolerance. We observed that RORγt(+) innate lymphoid cells (ILCs) are the primary source of GM-CSF in the gut and that ILC-driven GM-CSF production was dependent on the ability of macrophages to sense microbial signals and produce interleukin-1β. Our findings reveal that commensal microbes promote a crosstalk between innate myeloid and lymphoid cells that leads to immune homeostasis in the intestine.

Constant replenishment from circulating monocytes maintains the macrophage pool in adult intestine

PubMed Central

Scott, Charlotte L.; Perdiguero, Elisa Gomez; Geissmann, Frederic; Henri, Sandrine; Malissen, Bernard; Osborne, Lisa C.; Artis, David; Mowat, Allan McI.

2014-01-01

The paradigm that resident macrophages in steady-state tissues are derived from embryonic precursors has never been investigated in the intestine, which contains the largest pool of macrophages. Using fate mapping models and monocytopenic mice, together with bone marrow chimeric and parabiotic models, we show that embryonic precursors seeded the intestinal mucosa and demonstrated extensive in situ proliferation in the neonatal period. However these cells did not persist in adult intestine. Instead, they were replaced around the time of weaning by the CCR2-dependent influx of Ly6Chi monocytes that differentiated locally into mature, anti-inflammatory macrophages. This process was driven largely by the microbiota and had to be continued throughout adult life to maintain a normal intestinal macrophage pool. PMID:25151491

Arginine Consumption by the Intestinal Parasite Giardia intestinalis Reduces Proliferation of Intestinal Epithelial Cells

PubMed Central

Stadelmann, Britta; Merino, María C.; Persson, Lo; Svärd, Staffan G.

2012-01-01

In the field of infectious diseases the multifaceted amino acid arginine has reached special attention as substrate for the host´s production of the antimicrobial agent nitric oxide (NO). A variety of infectious organisms interfere with this part of the host immune response by reducing the availability of arginine. This prompted us to further investigate additional roles of arginine during pathogen infections. As a model we used the intestinal parasite Giardia intestinalis that actively consumes arginine as main energy source and secretes an arginine-consuming enzyme, arginine deiminase (ADI). Reduced intestinal epithelial cell (IEC) proliferation is a common theme during bacterial and viral intestinal infections, but it has never been connected to arginine-consumption. Our specific question was thereby, whether the arginine-consumption by Giardia leads to reduced IEC proliferation, in addition to NO reduction. In vitro cultivation of human IEC lines in arginine-free or arginine/citrulline-complemented medium, as well as in interaction with different G. intestinalis isolates, were used to study effects on host cell replication by MTT assay. IEC proliferation was further analyzed by DNA content analysis, polyamine measurements and expressional analysis of cell cycle regulatory genes. IEC proliferation was reduced upon arginine-withdrawal and also in an arginine-dependent manner upon interaction with G. intestinalis or addition of Giardia ADI. We show that arginine-withdrawal by intestinal pathogens leads to a halt in the cell cycle in IECs through reduced polyamine levels and upregulated cell cycle inhibitory genes. This is of importance with regards to intestinal tissue homeostasis that is affected through reduced cell proliferation. Thus, the slower epithelial cell turnover helps the pathogen to maintain a more stable niche for colonization. This study also shows why supplementation therapy of diarrhea patients with arginine/citrulline is helpful and that

European network for promoting the physical health of residents in psychiatric and social care facilities (HELPS): background, aims and methods

PubMed Central

Weiser, Prisca; Becker, Thomas; Losert, Carolin; Alptekin, Köksal; Berti, Loretta; Burti, Lorenzo; Burton, Alexandra; Dernovsek, Mojca; Dragomirecka, Eva; Freidl, Marion; Friedrich, Fabian; Genova, Aneta; Germanavicius, Arunas; Halis, Ulaş; Henderson, John; Hjorth, Peter; Lai, Taavi; Larsen, Jens Ivar; Lech, Katarzyna; Lucas, Ramona; Marginean, Roxana; McDaid, David; Mladenova, Maya; Munk-Jørgensen, Povl; Paziuc, Alexandru; Paziuc, Petronela; Priebe, Stefan; Prot-Klinger, Katarzyna; Wancata, Johannes; Kilian, Reinhold

2009-01-01

Background People with mental disorders have a higher prevalence of physical illnesses and reduced life expectancy as compared with the general population. However, there is a lack of knowledge across Europe concerning interventions that aim at reducing somatic morbidity and excess mortality by promoting behaviour-based and/or environment-based interventions. Methods and design HELPS is an interdisciplinary European network that aims at (i) gathering relevant knowledge on physical illness in people with mental illness, (ii) identifying health promotion initiatives in European countries that meet country-specific needs, and (iii) at identifying best practice across Europe. Criteria for best practice will include evidence on the efficacy of physical health interventions and of their effectiveness in routine care, cost implications and feasibility for adaptation and implementation of interventions across different settings in Europe. HELPS will develop and implement a "physical health promotion toolkit". The toolkit will provide information to empower residents and staff to identify the most relevant risk factors in their specific context and to select the most appropriate action out of a range of defined health promoting interventions. The key methods are (a) stakeholder analysis, (b) international literature reviews, (c) Delphi rounds with experts from participating centres, and (d) focus groups with staff and residents of mental health care facilities. Meanwhile a multi-disciplinary network consisting of 15 European countries has been established and took up the work. As one main result of the project they expect that a widespread use of the HELPS toolkit could have a significant positive effect on the physical health status of residents of mental health and social care facilities, as well as to hold resonance for community dwelling people with mental health problems. Discussion A general strategy on health promotion for people with mental disorders must take into

How Residents Learn From Patient Feedback: A Multi-Institutional Qualitative Study of Pediatrics Residents' Perspectives.

PubMed

Bogetz, Alyssa L; Orlov, Nicola; Blankenburg, Rebecca; Bhavaraju, Vasudha; McQueen, Alisa; Rassbach, Caroline

2018-04-01

Residents may view feedback from patients and their families with greater skepticism than feedback from supervisors and peers. While discussing patient and family feedback with faculty may improve residents' acceptance of feedback and learning, specific strategies have not been identified. We explored pediatrics residents' perspectives of patient feedback and identified strategies that promote residents' reflection on and learning from feedback. In this multi-institutional, qualitative study conducted in June and July 2016, we conducted focus groups with a purposive sample of pediatrics residents after their participation in a randomized controlled trial in which they received written patient feedback and either discussed it with faculty or reviewed it independently. Focus group transcripts were audiorecorded, transcribed, and analyzed for themes using the constant comparative approach associated with grounded theory. Thirty-six of 92 (39%) residents participated in 7 focus groups. Four themes emerged: (1) residents valued patient feedback but felt it may lack the specificity they desire; (2) discussing feedback with a trusted faculty member was helpful for self-reflection; (3) residents identified 5 strategies faculty used to facilitate their openness to and acceptance of patient feedback (eg, help resident overcome emotional responses to feedback and situate feedback in the context of lifelong learning); and (4) residents' perceptions of feedback credibility improved when faculty observed patient encounters and solicited feedback on the resident's behalf prior to discussions. Discussing patient feedback with faculty provided important scaffolding to enhance residents' openness to and reflection on patient feedback.

Irf4-dependent CD103+CD11b+ dendritic cells and the intestinal microbiome regulate monocyte and macrophage activation and intestinal peristalsis in postoperative ileus

PubMed Central

Pohl, Judith-Mira; Gutweiler, Sebastian; Thiebes, Stephanie; Volke, Julia K; Klein-Hitpass, Ludger; Zwanziger, Denise; Gunzer, Matthias; Jung, Steffen; Agace, William W; Kurts, Christian

2017-01-01

Objective Postoperative ileus (POI), the most frequent complication after intestinal surgery, depends on dendritic cells (DCs) and macrophages. Here, we have investigated the mechanism that activates these cells and the contribution of the intestinal microbiota for POI induction. Design POI was induced by manipulating the intestine of mice, which selectively lack DCs, monocytes or macrophages. The disease severity in the small and large intestine was analysed by determining the distribution of orally applied fluorescein isothiocyanate-dextran and by measuring the excretion time of a retrogradely inserted glass ball. The impact of the microbiota on intestinal peristalsis was evaluated after oral antibiotic treatment. Results We found that Cd11c-Cre+ Irf4flox/flox mice lack CD103+CD11b+ DCs, a DC subset unique to the intestine whose function is poorly understood. Their absence in the intestinal muscularis reduced pathogenic inducible nitric oxide synthase (iNOS) production by monocytes and macrophages and ameliorated POI. Pathogenic iNOS was produced in the jejunum by resident Ly6C– macrophages and infiltrating chemokine receptor 2-dependent Ly6C+ monocytes, but in the colon only by the latter demonstrating differential tolerance mechanisms along the intestinal tract. Consistently, depletion of both cell subsets reduced small intestinal POI, whereas the depletion of Ly6C+ monocytes alone was sufficient to prevent large intestinal POI. The differential role of monocytes and macrophages in small and large intestinal POI suggested a potential role of the intestinal microbiota. Indeed, antibiotic treatment reduced iNOS levels and ameliorated POI. Conclusions Our findings reveal that CD103+CD11b+ DCs and the intestinal microbiome are a prerequisite for the activation of intestinal monocytes and macrophages and for dysregulating intestinal motility in POI. PMID:28615301

Commensal-pathogen interactions in the intestinal tract

PubMed Central

Reynolds, Lisa A; Smith, Katherine A; Filbey, Kara J; Harcus, Yvonne; Hewitson, James P; Redpath, Stephen A; Valdez, Yanet; Yebra, María J; Finlay, B Brett; Maizels, Rick M

2016-01-01

The intestinal microbiota are pivotal in determining the developmental, metabolic and immunological status of the mammalian host. However, the intestinal tract may also accommodate pathogenic organisms, including helminth parasites which are highly prevalent in most tropical countries. Both microbes and helminths must evade or manipulate the host immune system to reside in the intestinal environment, yet whether they influence each other’s persistence in the host remains unknown. We now show that abundance of Lactobacillus bacteria correlates positively with infection with the mouse intestinal nematode, Heligmosomoides polygyrus, as well as with heightened regulatory T cell (Treg) and Th17 responses. Moreover, H. polygyrus raises Lactobacillus species abundance in the duodenum of C57BL/6 mice, which are highly susceptible to H. polygyrus infection, but not in BALB/c mice, which are relatively resistant. Sequencing of samples at the bacterial gyrB locus identified the principal Lactobacillus species as L. taiwanensis, a previously characterized rodent commensal. Experimental administration of L. taiwanensis to BALB/c mice elevates regulatory T cell frequencies and results in greater helminth establishment, demonstrating a causal relationship in which commensal bacteria promote infection with an intestinal parasite and implicating a bacterially-induced expansion of Tregs as a mechanism of greater helminth susceptibility. The discovery of this tripartite interaction between host, bacteria and parasite has important implications for both antibiotic and anthelmintic use in endemic human populations. PMID:25144609

Motherhood during residency training: challenges and strategies.

PubMed

Walsh, Allyn; Gold, Michelle; Jensen, Phyllis; Jedrzkiewicz, Michelle

2005-07-01

To determine what factors enable or impede women in a Canadian family medicine residency program from combining motherhood with residency training. To determine how policies can support these women, given that in recent decades the number of female family medicine residents has increased. Qualitative study using in-person interviews. McMaster University Family Medicine Residency Program. Twenty-one of 27 family medicine residents taking maternity leave between 1994 and 1999. Semistructured interviews. The research team reviewed transcripts of audiotaped interviews for emerging themes; consensus was reached on content and meaning. NVIVO software was used for data analysis. Long hours, unpredictable work demands, guilt because absences from work increase workload for colleagues, and residents' high expectations of themselves cause pregnant residents severe stress. This stress continues upon return to work; finding adequate child care is an added stress. Residents report receiving less support from colleagues and supervisors upon return to work; they associate this with no longer being visibly pregnant. Physically demanding training rotations put additional strain on pregnant residents and those newly returned to work. Flexibility in scheduling rotations can help accommodate needs at home. Providing breaks, privacy, and refrigerators at work can help maintain breastfeeding. Allowing residents to remain involved in academic and clinical work during maternity leave helps maintain clinical skills, build new knowledge, and promote peer support. Pregnancy during residency training is common and becoming more common. Training programs can successfully enhance the experience of motherhood during residency by providing flexibility at work to facilitate a healthy balance among the competing demands of family, work, and student life.

Do Residency Selection Factors Predict Radiology Resident Performance?

PubMed

Agarwal, Vikas; Bump, Gregory M; Heller, Matthew T; Chen, Ling-Wan; Branstetter, Barton F; Amesur, Nikhil B; Hughes, Marion A

2018-03-01

The purpose of our study is to determine what information in medical student residency applications predicts radiology residency success as defined by objective clinical performance data. We performed a retrospective cohort study of residents who entered our institution's residency program through the National Resident Matching Program as postgraduate year 2 residents and completed the program over the past 2 years. Medical school grades, selection to Alpha Omega Alpha (AOA) Honor Society, United States Medical Licensing Examination (USMLE) scores, publication in peer-reviewed journals, and whether the applicant was from a peer institution were the variables examined. Clinical performance was determined by calculating each resident's cumulative major discordance rate for on-call cases the resident read and gave a preliminary interpretation. A major discordance was defined as a difference between the preliminary resident and the final attending interpretations that could immediately impact the care of the patient. A multivariate logistic regression was performed to determine significant variables. Twenty-seven residents provided preliminary reports on call for 67,145 studies. The mean major discordance rate was 1.08% (range 0.34%-2.54%). Higher USMLE Step 1 scores, publication before residency, and election to AOA Honor Society were all statistically significant predictors of lower major discordance rates (P values 0.01, 0.01,  and <0.001, respectively). Overall resident performance was excellent. There are predictors that help select the better performing residents, namely higher USMLE Step 1 scores, one to two publications during medical school, and election to AOA in the junior year of medical school. Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Intestinal polyparasitism with special emphasis to soil-transmitted helminths among residents around Gilgel Gibe Dam, Southwest Ethiopia: a community based survey.

PubMed

Mekonnen, Zeleke; Suleman, Sultan; Biruksew, Abdissa; Tefera, Tamirat; Chelkeba, Legese

2016-11-23

One third of the world population is estimated to be infected with intestinal parasites. The most affected people are children and the poor people living in tropics and subtropics. Polyparasitism (the concurrent infection with multiple intestinal parasite species) is found to be the norm among the same population although accurate estimate of its magnitude is unknown. It was found that polyparasitism might have a greater impact on morbidity than single species infection which might also increase susceptibility to other infections. Therefore, this study aimed at determining the prevalence and distribution of intestinal polyparasitism with special emphasis on Soil-Transmitted Helminths (STH) among residents around Gilgel Gibe dam located in Jimma zone of Oromia regional state, Ethiopia. A total of 1,021 participants were recruited in this study and provided stool samples for parasitological examination. Direct wet mount and Kato-Katz techniques were employed for stool examination. Pearson chi-square test was employed to assess the association of infection status and polyparasitism with gender and age group of the study participants. Five hundred thirty two individuals were infected with at least one parasite, providing the overall prevalence of 52.1%. Among positive individuals, 405 (76.1%), 114 (21.4%), and 13 (2.5%) individuals were infected with only one, two and three species of parasites, respectively. The overall prevalence of intestinal polyparasitism observed among the study participants was 12.4% (127/1,021). The predominant STH was hookworm, with a prevalence of 44.1%. Hookworm and Ascaris lumbricoides were the most frequently recorded combination in cases of polyparasitic infection. The study revealed that there was no significant difference in the distribution of polyparasitism with regard to age group and sex of the study participants (p > 0.05). The study indicated the presence of high prevalence of parasites as well as distribution of

[Dolichomegacolon of the Andes and intestinal volvulus due to altitude].

PubMed

Frisancho, Oscar

2008-01-01

Sigmoid volvulus is a frequent cause of emergencies in hospitals in the Andean area, representing more than 50% of all intestinal obstructions. Andean dolichomegacolon (DCMA) and retractile mesocolonitis are the main contributing factors for volvulus. The mesocolonitis nears the proximal and distal segment of the sigmoid handle, favoring its torsion. Copious intake of fermentable food is the precipitating factor for volvulus. The majority of patients are seen during sowing and harvest periods, in which the consumption of this type of food increases. Andean people who live at an altitude of 3,000 m have a larger and thicker colon than coastal residents. We call this acquired characteristic the Andean dolichomegacolon (DCMA). A fiber-rich diet may inhibit the histological phenomenon known as elastogenesis, developing--over the years--the megacolon. Another important factor may be the lower atmospheric pressure in the altitude, and according to Boyle and Mariotte's physical law, the expansion of intraluminal gas may have an influence on intestinal enlargement. DCMA has many special anatomic, clinical, radiological, histological and serological features which make it different from the . chagasic megacolon. Mild emergency procedures may be performed to treat the sigmoid volvulus, such as endoscopic disvolvulation. Changing the colon rotation is helpful in diminishing abdominal pressure and restore complete blood circulation. An emergency surgery treatment must take the patient's general condition and the colon handle condition during surgery as a guiding point. High rates of mortality are found in relation to elderly patients, disease evolution time and stage of intestinal ischemia. Other new therapeutic procedures such as percutaneous sigmoidpexy, laparoscopic sigmoidectomy and mesosigmoplasty are under review, and have precise indications. Wider series are needed to evaluate them better.

Intestinal transplantation: The anesthesia perspective.

PubMed

Dalal, Aparna

2016-04-01

Intestinal transplantation is a complex and challenging surgery. It is very effective for treating intestinal failure, especially for those patients who cannot tolerate parenteral nutrition nor have extensive abdominal disease. Chronic parental nutrition can induce intestinal failure associated liver disease (IFALD). According to United Network for Organ Sharing (UNOS) data, children with intestinal failure affected by liver disease secondary to parenteral nutrition have the highest mortality on a waiting list when compared with all candidates for solid organ transplantation. Intestinal transplant grafts can be isolated or combined with the liver/duodenum/pancreas. Organ Procurement and Transplantation Network (OPTN) has defined intestinal donor criteria. Living donor intestinal transplant (LDIT) has the advantages of optimal timing, short ischemia time and good human leukocyte antigen matching contributing to lower postoperative complications in the recipient. Thoracic epidurals provide excellent analgesia for the donors, as well as recipients. Recipient management can be challenging. Thrombosis and obstruction of venous access maybe common due to prolonged parenteral nutrition and/or hypercoaguability. Thromboelastography (TEG) is helpful for managing intraoperative product therapy or thrombosis. Large fluid shifts and electrolyte disturbances may occur due to massive blood loss, dehydration, third spacing etc. Intestinal grafts are susceptible to warm and cold ischemia and ischemia-reperfusion injury (IRI). Post-reperfusion syndrome is common. Cardiac or pulmonary clots can be monitored with transesophageal echocardiography (TEE) and treated with recombinant tissue plasminogen activator. Vasopressors maybe used to ensure stable hemodynamics. Post-intestinal transplant patients may need anesthesia for procedures such as biopsies for surveillance of rejection, bronchoscopy, endoscopy, postoperative hemorrhage, anastomotic leaks, thrombosis of grafts etc. Asepsis

Intestinal Behçet's Disease: A True Inflammatory Bowel Disease or Merely an Intestinal Complication of Systemic Vasculitis?

PubMed Central

Kim, Duk Hwan

2016-01-01

Behçet's disease (BD) is a multi-systemic inflammatory disorder of an unknown etiology and shows a chronic recurrent clinical course. When the disease involves the alimentary tract, it is called intestinal BD because of its clinical importance. Intestinal BD is more frequently reported in East Asian countries than in Western or Middle Eastern countries. While any part of the gastrointestinal tract can be involved, the most common location of intestinal BD is the ileocecal area. A few, large, deep ulcerations with discrete border are characteristic endoscopic findings of intestinal BD. Currently, there is no single gold standard test or pathognomonic finding of intestinal BD. However, recently developed novel diagnostic criteria and a disease activity index have helped in assessing intestinal BD. As intestinal BD shares a lot of characteristics with inflammatory bowel disease, including genetic background, clinical manifestations, and therapeutic strategies, distinguishing between the two diseases in clinical practice is quite difficult. However, biologic agents such as anti-tumor necrosis factor α antibody shows a considerable efficacy similar to inflammatory bowel disease cases. It is important to distinguish and treat those two disease entities separately from the standpoint of precise medicine. Clinicians should require comprehensive knowledge regarding the similarities and differences between intestinal BD and inflammatory bowel disease for making an accurate clinical decision. PMID:26632379

Intestinal helminth co-infection and associated factors among tuberculosis patients in Arba Minch, Ethiopia.

PubMed

Alemu, Getaneh; Mama, Mohammedaman

2017-01-13

Helminths affect the outcome of tuberculosis by shifting cell mediated immune response to humoral and by total suppression of the host immune system. On the reverse, Mycobacterium infection favors immune escape of helminths. Therefore assessing helminth co-infection rate and predisposing factors in tuberculosis patients is mandatory to set strategies for better case management. Facility based cross-sectional study was conducted in Arba Minch to assess the prevalence and associated factors of intestinal helminths among pulmonary tuberculosis patients from January to August, 2016. A structured questionnaire was used to capture data about socio-demographic characteristics, clinical history and possible risk factors for intestinal helminth infections. Height and weight were measured to calculate body-mass index. Appropriate amount of stool was collected and processed by direct saline and formol-ether concentration techniques following standard protocols. All the data were analyzed using SPSS version 20.0. A total of 213 (57.3% male and 42.7% female) pulmonary tuberculosis patients were participated in the study. The overall co-infection rate of intestinal parasites was 26.3%. The infection rate of intestinal helminths account 24.4% and that of intestinal protozoa was 6.1%. Ascaris lumbricoides accounted the highest frequency of 11.3%. Living in rural residence (AOR = 3.175, 95% CI: 1.102-9.153, p = 0.032), Eating vegetables/ fruits without washing or peeling off (AOR = 2.208, 95% CI: 1.030-4.733, p = 0.042) and having body-mass index <18.5 (AOR = 3.511, 95% CI: 1.646-7.489, p = 0.001) were associated with intestinal helminth infection. The infection rate by intestinal helminths was 24.4%. Ascaris lumbricoides was the most prevalent helminth. Residence, habit of washing vegetables/fruits before use and body-mass index were associated factors with intestinal helminthiasis. Therefore health care providers should screen and treat TB patients for

CD4+ T Cell Help Guides Formation of CD103+ Lung-Resident Memory CD8+ T Cells during Influenza Viral Infection

PubMed Central

Laidlaw, Brian J.; Zhang, Nianzhi; Marshall, Heather D.; Staron, Mathew M.; Guan, Tianxia; Hu, Yinghong; Cauley, Linda S.; Craft, Joe; Kaech, Susan M.

2014-01-01

SUMMARY Tissue-resident memory T (Trm) cells provide enhanced protection against infection at mucosal sites. Here we found that CD4+ T cells are important for the formation of functional lung-resident CD8+ T cells after influenza virus infection. In the absence of CD4+ T cells, CD8+ T cells displayed reduced expression of CD103 (Itgae), were mislocalized away from airway epithelia, and demonstrated an impaired ability to recruit CD8+ T cells to the lung air-ways upon heterosubtypic challenge. CD4+ T cell-derived interferon-γ was necessary for generating lung-resident CD103+ CD8+ Trm CD8 T cells. Furthermore, expression of the transcription factor T-bet was increased in “unhelped” lung Trm cells, and a reduction in T-bet rescued CD103 expression in the absence of CD4+ T cell help. Thus, CD4+ T cell-dependent signals are important to limit expression of T-bet and allow for the development of CD103+ CD8+ Trm cells in the lung airways following respiratory infection. PMID:25308332

Measurement of intestinal edema using an impedance analyzer circuit.

PubMed

Radhakrishnan, Ravi S; Shah, Kunal; Xue, Hasen; Moore-Olufemi, Stacey D; Moore, Frederick A; Weisbrodt, Norman W; Allen, Steven J; Gill, Brijesh; Cox, Charles S

2007-03-01

Acute intestinal edema adversely affects intestinal transit, permeability, and contractility. Current resuscitation modalities, while effective, are associated with development of acute intestinal edema. Knowledge of levels of tissue edema would allow clinicians to monitor intestinal tissue water and may help prevent the detrimental effects of edema. However, there is no simple method to measure intestinal tissue water without biopsy. We sought to develop a tissue impedance analyzer to measure tissue edema, without the need for invasive biopsy. Oscillating voltage input was applied to the analyzer circuit and an oscilloscope measured the voltage output across any load. Rats were randomized to three groups: sham, mild edema (80 mL/kg of NS resuscitation), and severe edema (80 mL/kg of NS resuscitation with intestinal venous hypertension). Intestinal edema was measured by wet-to-dry tissue weight ratio. Bowel impedance was measured and converted to capacitance using a standard curve. Acute intestinal edema causes a significant increase in bowel capacitance. This capacitance can be used to predict tissue water concentration. Using an impedance analyzer circuit, it is possible to measure intestinal edema reliably and quickly. This may prove to be a useful tool in the resuscitation of critically ill patients.

Emerging insights on intestinal dysbiosis during bacterial infections☆

PubMed Central

Pham, Tu Anh N; Lawley, Trevor D

2014-01-01

Infection of the gastrointestinal tract is commonly linked to pathological imbalances of the resident microbiota, termed dysbiosis. In recent years, advanced high-throughput genomic approaches have allowed us to examine the microbiota in an unprecedented manner, revealing novel biological insights about infection-associated dysbiosis at the community and individual species levels. A dysbiotic microbiota is typically reduced in taxonomic diversity and metabolic function, and can harbour pathobionts that exacerbate intestinal inflammation or manifest systemic disease. Dysbiosis can also promote pathogen genome evolution, while allowing the pathogens to persist at high density and transmit to new hosts. A deeper understanding of bacterial pathogenicity in the context of the intestinal microbiota should unveil new approaches for developing diagnostics and therapies for enteropathogens. PMID:24581695

In Vivo Myeloperoxidase Imaging and Flow Cytometry Analysis of Intestinal Myeloid Cells.

PubMed

Hülsdünker, Jan; Zeiser, Robert

2016-01-01

Myeloperoxidase (MPO) imaging is a non-invasive method to detect cells that produce the enzyme MPO that is most abundant in neutrophils, macrophages, and inflammatory monocytes. While lacking specificity for any of these three cell types, MPO imaging can provide guidance for further flow cytometry-based analysis of tissues where these cell types reside. Isolation of leukocytes from the intestinal tract is an error-prone procedure. Here, we describe a protocol for intestinal leukocyte isolation that works reliable in our hands and allows for flow cytometry-based analysis, in particular of neutrophils.

The transit of dosage forms through the small intestine.

PubMed

Yuen, Kah-Hay

2010-08-16

The human small intestine, with its enormous absorptive surface area, is invariably the principal site of drug absorption. Hence, the residence time of a dosage form in this part of the gut can have a great influence on the absorption of the contained drug. Various methods have been employed to monitor the gastrointestinal transit of pharmaceutical dosage forms, but the use of gamma-scintigraphy has superceded all the other methods. However, careful consideration of the time interval for image acquisition and proper analysis of the scintigraphic data are important for obtaining reliable results. Most studies reported the mean small intestinal transit time of various dosage forms to be about 3-4h, being closely similar to that of food and water. The value does not appear to be influenced by their physical state nor the presence of food, but the timing of food intake following administration of the dosage forms can influence the small intestinal transit time. While the mean small intestinal transit time is quite consistent among dosage forms and studies, individual values can vary widely. There are differing opinions regarding the effect of density and size of dosage forms on their small intestinal transit properties. Some common excipients employed in pharmaceutical formulations can affect the small intestinal transit and drug absorption. There is currently a lack of studies regarding the effects of excipients, as well as the timing of food intake on the small intestinal transit of dosage forms and drug absorption. Copyright (c) 2010 Elsevier B.V. All rights reserved.

Regulation of intestinal protein metabolism by amino acids.

PubMed

Bertrand, Julien; Goichon, Alexis; Déchelotte, Pierre; Coëffier, Moïse

2013-09-01

Gut homeostasis plays a major role in health and may be regulated by quantitative and qualitative food intake. In the intestinal mucosa, an intense renewal of proteins occurs, at approximately 50% per day in humans. In some pathophysiological conditions, protein turnover is altered and may contribute to intestinal or systemic diseases. Amino acids are key effectors of gut protein turnover, both as constituents of proteins and as regulatory molecules limiting intestinal injury and maintaining intestinal functions. Many studies have focused on two amino acids: glutamine, known as the preferential substrate of rapidly dividing cells, and arginine, another conditionally essential amino acid. The effects of glutamine and arginine on protein synthesis appear to be model and condition dependent, as are the involved signaling pathways. The regulation of gut protein degradation by amino acids has been minimally documented until now. This review will examine recent data, helping to better understand how amino acids regulate intestinal protein metabolism, and will explore perspectives for future studies.

Endocrine disruptive effects of polychlorinated aromatic hydrocarbons on intestinal cholecystokinin in rats.

PubMed

Lee, H M; He, Q; Englander, E W; Greeley, G H

2000-08-01

The ubiquitous and persistent nature of polychlorinated aromatic hydrocarbons (PCAHs) in our environment and the risk of exposure to PCAHs have provoked concern over their potential toxicity. In humans, exposure to PCAHs is aimed chiefly at epithelial cells residing in the intestinal mucosa, because oral intake of contaminated food is a major source of PCAHs. The purpose of this study, therefore, was to examine the effects of chronic exposure to various PCAHs [i.e. 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), 2,3,4,7,8-pentachlorodibenzofuran (PeCDF), 3,3',4,4',5-pentachlorobiphenyl (PCB-126), and 2,2'4,4'5,5'-hexachlorobiphenyl (PCB-153)], given alone or as mixtures, on intestinal cholecystokinin (CCK) peptide and messenger RNA levels. We show that chronic PCAH treatment significantly lowers intestinal levels of stored CCK peptide. Intestinal CCK messenger RNA levels are not affected. In addition, 3,3',4,4',5-pentachlorobiphenyl treatment increased intestinal insulin-like growth factor-binding protein-3 levels in a dose-related manner. Acute 2,3,7,8-tetrachlorodibenzo-p-dioxin treatment of intestinal CCK cells lowered levels of CCK-processing enzymes (i.e. prohormone convertase-1 and -2). Together, these data indicate that PCAHs may decrease intestinal levels of stored CCK peptide by affecting the intestinal insulin-like growth factor system and CCK processing.

Stroma provides an intestinal stem cell niche in the absence of epithelial Wnts.

PubMed

Kabiri, Zahra; Greicius, Gediminas; Madan, Babita; Biechele, Steffen; Zhong, Zhendong; Zaribafzadeh, Hamed; Edison; Aliyev, Jamal; Wu, Yonghui; Bunte, Ralph; Williams, Bart O; Rossant, Janet; Virshup, David M

2014-06-01

Wnt/β-catenin signaling supports intestinal homeostasis by regulating proliferation in the crypt. Multiple Wnts are expressed in Paneth cells as well as other intestinal epithelial and stromal cells. Ex vivo, Wnts secreted by Paneth cells can support intestinal stem cells when Wnt signaling is enhanced with supplemental R-Spondin 1 (RSPO1). However, in vivo, the source of Wnts in the stem cell niche is less clear. Genetic ablation of Porcn, an endoplasmic reticulum resident O-acyltransferase that is essential for the secretion and activity of all vertebrate Wnts, confirmed the role of intestinal epithelial Wnts in ex vivo culture. Unexpectedly, mice lacking epithelial Wnt activity (Porcn(Del)/Villin-Cre mice) had normal intestinal proliferation and differentiation, as well as successful regeneration after radiation injury, indicating that epithelial Wnts are dispensable for these processes. Consistent with a key role for stroma in the crypt niche, intestinal stromal cells endogenously expressing Wnts and Rspo3 support the growth of Porcn(Del) organoids ex vivo without RSPO1 supplementation. Conversely, increasing pharmacologic PORCN inhibition, affecting both stroma and epithelium, reduced Lgr5 intestinal stem cells, inhibited recovery from radiation injury, and at the highest dose fully blocked intestinal proliferation. We conclude that epithelial Wnts are dispensable and that stromal production of Wnts can fully support normal murine intestinal homeostasis.

How can surgeons facilitate resident intraoperative decision-making?

PubMed

Hill, Katherine A; Dasari, Mohini; Littleton, Eliza B; Hamad, Giselle G

2017-10-01

Cognitive skills such as decision-making are critical to developing operative autonomy. We explored resident decision-making using a recollection of specific examples, from the attending surgeon and resident, after laparoscopic cholecystectomy. In a separate semi-structured interview, the attending and resident both answered five questions, regarding the resident's operative roles and decisions, ways the attending helped, times when the attending operated, and the effect of the relationship between attending and resident. Themes were extracted using inductive methods. Thirty interviews were completed after 15 cases. Facilitators of decision-making included dialogue, safe struggle, and appreciation for retraction. Aberrant case characteristics, anatomic uncertainties, and time pressures provided barriers. Attending-resident mismatches included descriptions of transitioning control to the attending. Reciprocal dialogue, including concept-driven feedback, is helpful during intraoperative teaching. Unanticipated findings impede resident decision-making, and we describe differences in understanding transfers of operative control. Given these factors, we suggest that pre-operative discussions may be beneficial. Copyright © 2017 Elsevier Inc. All rights reserved.

A pediatric residency research requirement to improve collaborative resident and faculty publication productivity.

PubMed

Kurahara, David K; Kogachi, Kaitlin; Yamane, Maya; Ly, Catherine L; Foster, Jennifer H; Masaki-Tesoro, Traci; Murai, Daniel; Rudoy, Raul

2012-08-01

Involvement in a research project can teach training physicians about the scientific process involved in medicine. For this reason, the University of Hawai'i pediatrics department developed a Residency Research Requirement and Program (RRRP) in 2001. We studied a 14-year time period before and after the RRRP was initiated, and found a greater then ten-fold increase in resident publications and faculty involvement in these projects. Many of these manuscripts were the result of resident collaboration and this also increased significantly. The residents who later went into fellowship training were found to be more likely to publish their work. An RRRP encourages residents and faculty to become involved in research publications and other scholarly activities. Its development may help to motivate training physicians to learn important research skills.

Isolation and Phenotyping of Intestinal Macrophages.

PubMed

Petit, Vanessa

2018-01-01

Macrophages are one of the most abundant leucocytes in the intestinal mucosa where they are essential for maintaining homeostasis. However they are also implicated in the pathogenesis of disorders such as inflammatory bowel disease (IBD), offering potential targets for novel therapies.Tissue macrophages are a heterogeneous population of immune cells that fulfill tissue-specific and niche-specific functions. These unique phenotypes likely reflect the heterogeneity of tissue macrophage origins and influence the tissue environment in which they reside. Here we describe how we can characterize and isolate the colonic macrophages.

Intestinal Alkaline Phosphatase Detoxifies Lipopolysaccharide and Prevents Inflammation in Response to the Gut Microbiota

PubMed Central

Bates, Jennifer M.; Akerlund, Janie; Mittge, Erika; Guillemin, Karen

2009-01-01

SUMMARY Vertebrates harbor abundant lipopolysaccharide (LPS) or endotoxin in their gut microbiota. Here we demonstrate that the brush border enzyme intestinal alkaline phosphatase (Iap), which dephosphorylates LPS, is induced during establishment of the microbiota and plays a crucial role in promoting mucosal tolerance to gut bacteria in zebrafish. We demonstrate that Iap deficient animals are hypersensitive to LPS toxicity through a mechanism mediated by Myd88 and Tumor Necrosis Factor Receptor (Tnfr). We further show that the endogenous microbiota establish the normal homeostatic level of neutrophils in the intestine through a process involving Myd88 and Tnfr. Iap deficient animals exhibit excessive intestinal neutrophil influx, similar to wild type animals exposed to LPS. When reared germ-free, however, the intestines of Iap deficient animals are devoid of neutrophils, demonstrating that Iap functions to prevent inflammatory responses to resident gut bacteria. PMID:18078689

Does medical school research productivity predict a resident's research productivity during residency?

PubMed

Kohlert, Scott; Zuccaro, Laura; McLean, Laurie; Macdonald, Kristian

2017-04-27

Research productivity is an important component of the CanMEDS Scholar role and is an accreditation requirement of Canadian Otolaryngology training programs. Our objective was to determine if an association exists between publication rates before and during Otolaryngology residency. We obtained the names for all certified Canadian Otolaryngologists who graduated between 1998 and 2013 inclusive, and conducted a Medline search for all of their publications. Otolaryngologists were subgrouped based on year of residency graduation and the number of articles published pre-residency and during residency (0 or ≥1). Chi-squared analyses were used to evaluate whether publications pre-residency and year of graduation were associated with publications during residency. We obtained data for 312 Canadian Otolaryngologists. Of those 312 graduates, 46 (14.7%) had no identifiable publications on PubMed and were excluded from the final data analysis. Otolaryngology residents had a mean 0.65 (95% CI 0.50-0.80) publications before residency and 3.35 (95% CI 2.90-3.80) publications during residency. Between 1998 and 2013, mean publication rates before and during residency both increased significantly (R 2  = 0.594 and R 2  = 0.759, respectively), whereas publication rates after residency graduation has stagnated (R 2  = 0.023). The odds of publishing during residency was 5.85 times higher (95% CI 2.69-12.71) if a resident published prior to residency (p < 0.0001). The Spearman correlation coefficient between publications before and during residency is 0.472 (p < 0.0001). Residents who publish at least one paper before residency are nearly six times as likely to publish during residency than those who did not publish before residency. These findings may help guide Otolaryngology program selection committees in ranking the best CaRMS candidates.

A novel online didactic curriculum helps improve knowledge acquisition among non-emergency medicine rotating residents.

PubMed

Branzetti, Jeremy B; Aldeen, Amer Z; Foster, Andrew W; Courtney, D Mark

2011-01-01

Rotating residents represent a significant proportion of housestaff in academic emergency departments (EDs), yet they rarely receive targeted didactic education during their emergency medicine (EM) rotations. The goals of this study were: 1) to determine the effectiveness of an online didactic curriculum in improving EM knowledge among rotating residents and 2) to assess rotating resident satisfaction with this curriculum. The authors created an online lecture series of six EM subject areas targeted to rotating residents called the Northwestern University Rotating Resident Curriculum (NURRC). All rotating residents at the study site were eligible, written consent was obtained, and the study was approved by the institutional review board. Consenting participants were pretested with a 42-question multiple-choice examination and then randomized to two groups: one with access to the NURRC during the first 2 weeks of the rotation (experimental) and one without (control). Halfway through the rotation, all participants were post-tested with a different multiple-choice examination, and the controls were then granted NURRC access. The primary outcome was the difference between pretest and posttest scores (score delta). The t-test was used to compare mean scores, and a linear regression model was used to determine the association of NURRC access on score delta after adjustment for pretest type and resident type. A postintervention survey was administered at the end of the rotation to assess satisfaction with the NURRC and collect suggestions for improvement. Fifty-four rotating residents were enrolled: 29 in the experimental group and 25 in the control group. There was no significant difference in pretest scores between the two groups. Mean score delta was 17.3% in the experimental group and 1.6% in the control group, an absolute difference of 15.7% (95% confidence interval [CI]=10% to 22%). After adjustment for resident type and pretest type, the only variable positively

Enterohaemorrhagic Escherichia coli gains a competitive advantage by using ethanolamine as a nitrogen source in the bovine intestinal content.

PubMed

Bertin, Yolande; Girardeau, J P; Chaucheyras-Durand, F; Lyan, Bernard; Pujos-Guillot, Estelle; Harel, Josée; Martin, Christine

2011-02-01

The bovine gastrointestinal tract is the main reservoir for enterohaemorrhagic Escherichia coli (EHEC) responsible for food-borne infections. Characterization of nutrients that promote the carriage of these pathogens by the ruminant would help to develop ecological strategies to reduce their survival in the bovine gastrointestinal tract. In this study, we show for the first time that free ethanolamine (EA) constitutes a nitrogen source for the O157:H7 EHEC strain EDL933 in the bovine intestinal content because of induction of the eut (ethanolamine utilization) gene cluster. In contrast, the eut gene cluster is absent in the genome of most species constituting the mammalian gut microbiota. Furthermore, the eutB gene (encoding a subunit of the enzyme that catalyses the release of ammonia from EA) is poorly expressed in non-pathogenic E. coli. Accordingly, EA is consumed by EHEC but is poorly metabolized by endogenous microbiota of the bovine small intestine, including commensal E. coli. Interestingly, the capacity to utilize EA as a nitrogen source confers a growth advantage to E. coli O157:H7 when the bacteria enter the stationary growth phase. These data demonstrate that EHEC strains take advantage of a nitrogen source that is not consumed by the resident microbiota, and suggest that EA represents an ecological niche favouring EHEC persistence in the bovine intestine.

A metagenomic study of the preventive effect of Lactobacillus rhamnosus GG on intestinal polyp formation in ApcMin/+ mice.

PubMed

Ni, Y; Wong, V H Y; Tai, W C S; Li, J; Wong, W Y; Lee, M M L; Fong, F L Y; El-Nezami, H; Panagiotou, G

2017-03-01

To investigate the in vivo effects of Lactobacillus rhamnosus GG (LGG) on intestinal polyp development and the interaction between this single-organism probiotic and the gut microbiota therein. The Apc Min/+ mouse model was used to study the potential preventive effect of LGG on intestinal polyposis, while shotgun metagenomic sequencing was employed to characterize both taxonomic and functional changes within the gut microbial community. We found that the progression of intestinal polyps in the control group altered the community functional profile remarkably despite small variation in the taxonomic diversity. In comparison, the consumption of LGG helped maintain the overall functional potential and taxonomic profile in the resident microbes, thereby leading to a 25% decrease of total polyp counts. Furthermore, we found that LGG enriched those microbes or microbial activities related to short-chain fatty acid production (e.g. Roseburia and Coprococcus), as well as suppressed the ones that can lead to inflammation (e.g. Bilophila wadsworthia). Our study using shotgun metagenomics highlights how single probiotic LGG may exert its beneficial effects and decrease polyp formation in mice by maintaining gut microbial functionality. This probiotic intervention targeting microbiota may be used in conjugation with other dietary supplements or drugs as part of prevention strategies for early-stage colon cancer, after further clinical validations in human. © 2016 The Society for Applied Microbiology.

Research training during medical residency (MIR). Satisfaction questionnaire.

PubMed

Ríos Zambudio, A; Sánchez Gascón, F; González Moro, L; Guerrero Fernández, M

2004-10-01

It is during Medical Residency Training (MIR) that knowledge, abilities and habits are acquired, which will shape professional activity in the future. It is therefore very likely that residents who do not acquire the necessary habits and knowledge for research activities will eventually not carry out these activities in the future. The aim of this study was to analyze the level of satisfaction of residents with his or her scientific and research training, and to determine any deficiencies with respect to this training. The aim of the questionnaire used was to determine the level of satisfaction of residents regarding their scientific and research training during their residency period. Questionnaires were usually distributed via internal mail to all residents (MIR physicians) registered at a third level teaching hospital, with a completion rate of 78% (n = 178). As far as the evaluation of scientific training is concerned, 68% of residents were dissatisfied or very dissatisfied. With respect to scientific studies carried out, 49% of residents had not taken part in any, but the number of studies carried out increases as the residency progresses. On the other hand, 22% of residents reported not having started their doctoral thesis, 50% having attended doctorate courses, 24% having a title for their thesis, and only 4% having written a thesis. Doctorate courses, thesis topics, and written theses increase with the year of residency, and a greater activity may be seen in this respect in surgical departments. If we analyze help available to residents for their carrying out scientific activities, 55% reported that only selected assistant doctors would offer help, and 21% reported that no doctors would offer help. Dissatisfaction with research training increases with the year of residency. With regard to main specialist fields, it can be seen that residents in surgical fields carry out more theses, whereas central fields report less facilities. Finally, if we evaluate the

Intestinal toxemia botulism in 3 adults, Ontario, Canada, 2006-2008.

PubMed

Sheppard, Yolanda D; Middleton, Dean; Whitfield, Yvonne; Tyndel, Felix; Haider, Shariq; Spiegelman, Jamie; Swartz, Richard H; Nelder, Mark P; Baker, Stacey L; Landry, Lisa; Maceachern, Ross; Deamond, Sherri; Ross, Lorrie; Peters, Garth; Baird, Michelle; Rose, David; Sanders, Greg; Austin, John W

2012-01-01

Five cases of intestinal toxemia botulism in adults were identified within an 18-month period in or near Toronto, Ontario, Canada. We describe findings for 3 of the 5 case-patients. Clinical samples contained Clostridium botulinum spores and botulinum neurotoxins (types A and B) for extended periods (range 41-61 days), indicative of intestinal toxemia botulism. Patients' clinical signs improved with supportive care and administration of botulinum antitoxin. Peanut butter from the residence of 1 case-patient yielded C. botulinum type A, which corresponded with type A spores found in the patient's feces. The food and clinical isolates from this case-patient could not be distinguished by pulsed-field gel electrophoresis. Two of the case-patients had Crohn disease and had undergone previous bowel surgery, which may have contributed to infection with C. botulinum. These cases reinforce the view that an underlying gastrointestinal condition is a risk factor for adult intestinal toxemia botulism.

E-Learning and Medical Residents, a Qualitative Perspective

ERIC Educational Resources Information Center

Segerman, Jill; Crable, Elaine; Brodzinski, James

2016-01-01

Medical education helps ensure doctors acquire skills and knowledge needed to care for patients. However, resident duty hour restrictions have impacted the time residents have available for medical education, leaving resident educators searching for alternate options for effective medical education. Classroom situated e-learning, a blended…

Anesthesiology residents' perspective about good teaching--a qualitative needs assessment.

PubMed

Ortwein, Heiderose; Blaum, Wolf E; Spies, Claudia D

2014-01-01

Germany, like many other countries, will soon have a shortage of qualified doctors. One reason for the dissatisfaction amongst medical residents are the relatively unstructured residency training programs despite increasing importance of outcome-based education. The aim of our study was to identify characteristics and requirements for good teaching during anesthesiology residency training from the resident's point of view. A consensus workshop with residents from all medical universities in Germany was held. Participants were allocated to one of the three topics, chosen based on a 2009 nationwide evaluation of residency. The three topics were (A) characteristics of helpful/good teachers, (B) characteristics of helpful/good conditions and (C) characteristics of helpful/good curricular structure. Each group followed a nominal group technique consensus process to define and rank characteristics for a good residency. 31 (79.5%) resident representatives were present. The consented results put emphasis on the importance of structured curricula including transparent goals and objectives, in training formative assessments and quality assurance measures for the program. Residents further long for trained trainers with formal teaching qualifications and protected teaching time. Good residency training requires careful consideration of all stakeholders' needs. Results reflect and extend previous findings and are at least to some degree easily implemented. These findings are an important step to establish a broader consensus within the discipline.

[Adult intestinal malrotation associated with intestinal volvulus].

PubMed

Hernando-Almudí, Ernesto; Cerdán-Pascual, Rafael; Vallejo-Bernad, Cristina; Martín-Cuartero, Joaquín; Sánchez-Rubio, María; Casamayor-Franco, Carmen

Intestinal malrotation is a congenital anomaly of the intestinal rotation and fixation, and usually occurs in the neonatal age. Description of a clinical case associated with acute occlusive symptoms. A case of intestinal malrotation is presented in a previously asymptomatic woman of 46 years old with an intestinal obstruction, with radiology and surgical findings showing an absence of intestinal rotation. Intestinal malrotation in adults is often asymptomatic, and is diagnosed as a casual finding during a radiological examination performed for other reasons. Infrequently, it can be diagnosed in adults, associated with an acute abdomen. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

Radiology resident teaching skills improvement: impact of a resident teacher training program.

PubMed

Donovan, Andrea

2011-04-01

Teaching is considered an essential competency for residents to achieve during their training. Instruction in teaching skills may assist radiology residents in becoming more effective teachers and increase their overall satisfaction with teaching. The purposes of this study were to survey radiology residents' teaching experiences during residency and to assess perceived benefits following participation in a teaching skills development course. Study participants were radiology residents with membership in the American Alliance of Academic Chief Residents in Radiology or the Siemens AUR Radiology Resident Academic Development Program who participated in a 1.5-hour workshop on teaching skills development at the 2010 Association of University Radiologists meeting. Participants completed a self-administered, precourse questionnaire that addressed their current teaching strategies, as well as the prevalence and structure of teaching skills training opportunities at their institutions. A second postcourse questionnaire enabled residents to evaluate the seminar and assessed new knowledge and skill acquisition. Seventy-eight residents completed the precourse and postcourse questionnaires. The vast majority of respondents indicated that they taught medical students (72 of 78 [92.3%]). Approximately 20% of residency programs (17 of 78) provided residents with formal didactic programs on teaching skills. Fewer than half (46.8%) of the resident respondents indicated that they received feedback on their teaching from attending physicians (36 of 77), and only 18% (13 of 78) routinely gave feedback to their own learners. All of the course participants agreed or strongly agreed that this workshop was helpful to them as teachers. Few residency programs had instituted resident teacher training curricula. A resident teacher training workshop was perceived as beneficial by the residents, and they reported improvement in their teaching skills. Copyright © 2011 AUR. Published by

Facilty Focus: Residence Halls.

ERIC Educational Resources Information Center

Hunnewell, James F., Jr.

2002-01-01

Describes the Western Ridge Residence at Colorado College and Beard Hall at Wheaton College. The buildings feature multiple levels that take advantage of views and also help create a "homey" feeling. (EV)

The Inside Story of Shigella Invasion of Intestinal Epithelial Cells

PubMed Central

Carayol, Nathalie; Tran Van Nhieu, Guy

2013-01-01

As opposed to other invasive pathogens that reside into host cells in a parasitic mode, Shigella, the causative agent of bacillary dysentery, invades the colonic mucosa but does not penetrate further to survive into deeper tissues. Instead, Shigella invades, replicates, and disseminates within the colonic mucosa. Bacterial invasion and spreading in intestinal epithelium lead to the elicitation of inflammatory responses responsible for the tissue destruction and shedding in the environment for further infection of other hosts. In this article, we highlight specific features of the Shigella arsenal of virulence determinants injected by a type III secretion apparatus (T3SA) that point to the targeting of intestinal epithelial cells as a discrete route of invasion during the initial event of the infectious process. PMID:24086068

Understanding How Commensal Obligate Anaerobic Bacteria Regulate Immune Functions in the Large Intestine

PubMed Central

Maier, Eva; Anderson, Rachel C.; Roy, Nicole C.

2014-01-01

The human gastrointestinal tract is colonised by trillions of commensal bacteria, most of which are obligate anaerobes residing in the large intestine. Appropriate bacterial colonisation is generally known to be critical for human health. In particular, the development and function of the immune system depends on microbial colonisation, and a regulated cross-talk between commensal bacteria, intestinal epithelial cells and immune cells is required to maintain mucosal immune homeostasis. This homeostasis is disturbed in various inflammatory disorders, such as inflammatory bowel diseases. Several in vitro and in vivo studies indicate a role for Faecalibacterium prausnitzii, Bacteroides thetaiotaomicron, Bacteroides fragilis, Akkermansia muciniphila and segmented filamentous bacteria in maintaining intestinal immune homeostasis. These obligate anaerobes are abundant in the healthy intestine but reduced in several inflammatory diseases, suggesting an association with protective effects on human health. However, knowledge of the mechanisms underlying the effects of obligate anaerobic intestinal bacteria remains limited, in part due to the difficulty of co-culturing obligate anaerobes together with oxygen-requiring human epithelial cells. By using novel dual-environment co-culture models, it will be possible to investigate the effects of the unstudied majority of intestinal microorganisms on the human epithelia. This knowledge will provide opportunities for improving human health and reducing the risk of inflammatory diseases. PMID:25545102

Understanding how commensal obligate anaerobic bacteria regulate immune functions in the large intestine.

PubMed

Maier, Eva; Anderson, Rachel C; Roy, Nicole C

2014-12-24

The human gastrointestinal tract is colonised by trillions of commensal bacteria, most of which are obligate anaerobes residing in the large intestine. Appropriate bacterial colonisation is generally known to be critical for human health. In particular, the development and function of the immune system depends on microbial colonisation, and a regulated cross-talk between commensal bacteria, intestinal epithelial cells and immune cells is required to maintain mucosal immune homeostasis. This homeostasis is disturbed in various inflammatory disorders, such as inflammatory bowel diseases. Several in vitro and in vivo studies indicate a role for Faecalibacterium prausnitzii, Bacteroides thetaiotaomicron, Bacteroides fragilis, Akkermansia muciniphila and segmented filamentous bacteria in maintaining intestinal immune homeostasis. These obligate anaerobes are abundant in the healthy intestine but reduced in several inflammatory diseases, suggesting an association with protective effects on human health. However, knowledge of the mechanisms underlying the effects of obligate anaerobic intestinal bacteria remains limited, in part due to the difficulty of co-culturing obligate anaerobes together with oxygen-requiring human epithelial cells. By using novel dual-environment co-culture models, it will be possible to investigate the effects of the unstudied majority of intestinal microorganisms on the human epithelia. This knowledge will provide opportunities for improving human health and reducing the risk of inflammatory diseases.

Residence Hall Fires.

ERIC Educational Resources Information Center

Wright, Dorothy

1999-01-01

Discusses how one college's experience with a tragic fire in one of its residence halls prompted a reevaluation of its fire-prevention-and-response strategies. Staff training, sprinkler installation, new alarm systems, and exit hardware to help make building exiting more efficient are discussed. (GR)

Intestinal alkaline phosphatase detoxifies lipopolysaccharide and prevents inflammation in zebrafish in response to the gut microbiota.

PubMed

Bates, Jennifer M; Akerlund, Janie; Mittge, Erika; Guillemin, Karen

2007-12-13

Vertebrates harbor abundant lipopolysaccharide (LPS) in their gut microbiota. Alkaline phosphatases can dephosphorylate and detoxify the endotoxin component of LPS. Here, we show that expression of the zebrafish intestinal alkaline phosphatase (Iap), localized to the intestinal lumen brush border, is induced during establishment of the gut microbiota. Iap-deficient zebrafish are hypersensitive to LPS toxicity and exhibit the excessive intestinal neutrophil influx characteristic of wild-type zebrafish exposed to LPS. Both of these Iap mutant phenotypes are dependent on Myd88 and Tumor Necrosis Factor Receptor (Tnfr), proteins also involved in LPS sensitivity in mammals. When reared germ-free, the intestines of Iap-deficient zebrafish are devoid of neutrophils. Together, these findings demonstrate that the endogenous microbiota establish the normal homeostatic level of neutrophils in the zebrafish intestine through a process involving Iap, Myd88, and Tnfr. Thus, by preventing inflammatory responses, Iap plays a crucial role in promoting mucosal tolerance to resident gut bacteria.

Infection with HIV and intestinal parasites among street dwellers in Gondar city, northwest Ethiopia.

PubMed

Moges, Feleke; Kebede, Yenew; Kassu, Afework; Degu, Getu; Tiruneh, Moges; Gedefaw, Molla

2006-12-01

In Ethiopia human immunodeficiency virus (HIV) infection is a major health and socioeconomic problem. Sex workers, youth, and mobile populations all show increasing prevalence of HIV. However, there is currently no information about the seroprevalence of HIV and the knowledge of HIV among street dwellers in the country. To fill this gap, 404 street dwellers residing in Gondar, northwest Ethiopia, were included in this cross-sectional study. Socio-demographic data, factors that prompted the subjects to become street dwellers, and their knowledge about HIV were all assessed using a structured questionnaire. Stool samples for diagnosis of intestinal parasites and venous blood for HIV antibody testing were collected and processed following standard procedures. Poverty-associated movement to urban areas in search of work was reported as a major factor that forced them to live in the streets, followed by divorce, family death, and addiction and peer pressure. One or more intestinal parasites were found in 67.6% of the street dwellers. Multiple parasitic infections were detected in 27.7%. The prevalence of HIV in the street dwellers was 6.9%. Fifty-nine (16.6%) participants responded that HIV can be transmitted by eating food together. Seventy-three (18%) believed an infected needle cannot transmit HIV, while 51 (12.6%) said HIV can be transmitted by hand shaking. One hundred ninety-two (47.5%) responded that antiretroviral therapy will not prolong the life of HIV-infected individuals. In summary, the prevalence of HIV and intestinal parasitic infection was quite high among street dwellers in Gondar. Therefore, strategies to control HIV and other infectious diseases should include this group, and regular mass deworming may help to reduce the burden of infection.

Anatomical and histological characteristics of the intestine of the topmouth culter (Culter alburnus).

PubMed

Cao, X J; Wang, W M; Song, F

2011-08-01

With 3 figures and 1 table Topmouth culter (Culter alburnus), a freshwater carnivorous fish of the Cyprinidae, is one of the most popular fish species in aquatic market in China. The anatomy and histology features of fish intestine are very useful for understanding digestive physiology, diagnosing some intestinal diseases and formulating suitable feeds. Thus, here we first characterize topmouth culter intestine via light microscope, transmission electron microscope and scan electron microscope. The 'Z' shaped intestine can be divided into three parts (e.g. the anterior intestine, middle intestine and posterior intestine), with an intestinal coefficient of 0.68. The anterior intestine possessed the longest mucosa folds and thickest muscularis among the three intestinal parts, and microvilli were very well-developed whilst many mitochondria, endoplasmic reticulums and lysosomes were found in which. This indicated the anterior intestine was a main region for digestion and absorption of food in the topmouth culter. While the vacuoles observed in the posterior intestine may be closely related to the intracellular digestion. Neutral and acid mucus were strongly present throughout the intestine. This detailed descriptive paper will be very helpful for studies of topmouth culter related to its digestive physiology, intestinal disease control and feed nutrient. © 2011 Blackwell Verlag GmbH.

Intestinal microbiota, probiotics and mental health: from Metchnikoff to modern advances: Part II - contemporary contextual research.

PubMed

Bested, Alison C; Logan, Alan C; Selhub, Eva M

2013-03-14

In recent years there has been a renewed interest concerning the ways in which the gastrointestinal tract - its functional integrity and microbial residents - might influence human mood (e.g. depression) and behavioral disorders. Once a hotbed of scientific interest in the early 20th century, this area lay dormant for decades, in part due to its association with the controversial term 'autointoxication'. Here we review contemporary findings related to intestinal permeability, small intestinal bacterial overgrowth, lipopolysaccharide endotoxin (LPS) exposure, D-lactic acid, propionic acid, and discuss their relevance to microbiota and mental health. In addition, we include the context of modern dietary habits as they relate to depression, anxiety and their potential interaction with intestinal microbiota.

Effects of prebiotics, probiotics, and their combination on growth performance, small intestine morphology, and resident Lactobacillus of male broilers.

PubMed

Wang, X; Farnell, Y Z; Peebles, E D; Kiess, A S; Wamsley, K G S; Zhai, W

2016-06-01

Effects of commercial antimicrobials and the individual and combinational use of commercial prebiotics and probiotics in feed from d zero to 41 on the growth performance, small intestine size, jejunal morphology, and ileal resident bacteria population of broiler chickens were determined. A total of 1,040 one-day-old male Ross × Ross 708 broilers were randomly distributed to 80 floor pens (5 treatments, 16 replications per treatment, 13 chicks per pen). Five dietary treatments were employed: 1) a corn soybean-meal basal diet (served as a negative control diet, NC); 2) a basal diet supplemented with a commercial prebiotic product (Pre); 3) a basal diet supplemented with a probiotic product containing Bacillus subtilis spores (Pro); 4) a basal diet supplemented with both prebiotic and probiotic products (Pre + Pro); and 5) a basal diet supplemented with commercial antimicrobials (served as a positive control diet, PC). At d 14, Pre diets improved the relative level of Lactobacillus in ileal mucosa as compared to NC, Pro, or PC diets (P = 0.045) without improving broiler BW. Broilers fed PC diets exhibited the highest BW gain from d 15 to 27, the lowest duodenum, jejunum, and ileum relative weights as percentage of BW at d 27, and the highest breast weight at d 42 (P = 0.026, 0.035, 0.002, 0.025, and 0.035, respectively). Broilers fed Pro or Pre + Pro diets exhibited higher BW gain from d 28 to 41 (P = 0.005) and higher overall BW gain from d zero to 41 (P = 0.039) than those fed other diets. Dietary treatments did not affect jejunal morphology or ileal resident Escherichia coli level at any age. From our results, including spores of Bacillus subtilis in feed may stimulate growth at a later age and may facilitate broilers in reaching their target weight sooner. Therefore, probiotics are recommended as potential alternatives to antimicrobials in chicken diets, especially in grower and finisher feed. © 2016 Poultry Science Association Inc.

Program for developing leadership in pharmacy residents.

PubMed

Fuller, Patrick D

2012-07-15

An innovative, structured approach to incorporating leadership development activities into pharmacy residency training is described. The American Society of Health-System Pharmacists (ASHP) has called for increased efforts to make leadership development an integral component of the training of pharmacy students and new practitioners. In 2007, The Nebraska Medical Center (TNMC) took action to systematize leadership training in its pharmacy residency programs by launching a new Leadership Development Series. Throughout the residency year, trainees at TNMC participate in a variety of activities: (1) focused group discussions of selected articles on leadership concepts written by noted leaders of the past and present, (2) a two-day offsite retreat featuring trust-building exercises and physical challenges, (3) a self-assessment designed to help residents identify and use their untapped personal strengths, (4) training on the effective application of different styles of communication and conflict resolution, and (5) education on the history and evolution of health-system pharmacy, including a review and discussion of lectures by recipients of ASHP's Harvey A. K. Whitney Award. Feedback from residents who have completed the series has been positive, with many residents indicating that it has stimulated their professional growth and helped prepared them for leadership roles. A structured Leadership Development Series exposes pharmacy residents to various leadership philosophies and principles and, through the study of Harvey A. K. Whitney Award lectures, to the thoughts of past and present pharmacy leaders. Residents develop an increased self-awareness through a resident fall retreat, a StrengthsFinder assessment, and communication and conflict-mode assessment tools.

Intestinal alkaline phosphatase deficiency leads to dysbiosis and bacterial translocation in the newborn intestine.

PubMed

Fawley, Jason; Koehler, Shannon; Cabrera, Susan; Lam, Vy; Fredrich, Katherine; Hessner, Martin; Salzman, Nita; Gourlay, David

2017-10-01

Intestinal alkaline phosphatase (IAP) has been shown to help maintain intestinal homeostasis. Decreased expression of IAP has been linked with pediatric intestinal diseases associated with bacterial overgrowth and subsequent inflammation. We hypothesize that the absence of IAP leads to dysbiosis, with increased inflammation and permeability of the newborn intestine. Sprague-Dawley heterozygote IAP cross-matches were bred. Pups were dam fed ad lib and euthanized at weaning. The microbiotas of terminal ileum (TI) and colon was determined by quantitative real-time polymerase chain reaction (qRT-PCR) of subphylum-specific bacterial 16S ribosomal RNA. RT-PCR was performed on TI for inflammatory cytokines. Intestinal permeability was quantified by fluorescein isothiocyanate-dextran permeability and bacterial translocation by qRT-PCR for bacterial 16S ribosomal RNA in mesenteric lymph nodes. Statistical analysis was done by chi-square analysis. All three genotypes had similar concentrations of bacteria in the TI and colon. However, IAP knockout (IAP-KO) had significantly decreased diversity of bacterial species in their colonic stool compared with heterozygous and wild-type (WT). IAP-KO pups had a nonstatistically significant 3.9-fold increased inducible nitric oxide synthase messenger RNA expression compared with WT (IAP-KO, 3.92 ± 1.36; WT, 1.0 ± 0.27; P = 0.03). IAP-KO also had significantly increased bacterial translocation to mesenteric lymph nodes occurred in IAP-KO (IAP-KO, 7625 RFU/g ± 3469; WT, 4957 RFU/g ± 1552; P = 0.04). Furthermore, IAP-KO had increased permeability (IAP-KO, 0.297 mg/mL ± 0.2; WT, 0.189 mg/mL ± 0.15 P = 0.07), but was not statistically significant. Deficiency of IAP in the newborn intestine is associated with dysbiosis and increased inflammation, permeability, and bacterial translocation. Copyright © 2017 Elsevier Inc. All rights reserved.

Insights into Vibrio cholerae Intestinal Colonization from Monitoring Fluorescently Labeled Bacteria

PubMed Central

Millet, Yves A.; Alvarez, David; Ringgaard, Simon; von Andrian, Ulrich H.; Davis, Brigid M.; Waldor, Matthew K.

2014-01-01

Vibrio cholerae, the agent of cholera, is a motile non-invasive pathogen that colonizes the small intestine (SI). Most of our knowledge of the processes required for V. cholerae intestinal colonization is derived from enumeration of wt and mutant V. cholerae recovered from orogastrically infected infant mice. There is limited knowledge of the distribution of V. cholerae within the SI, particularly its localization along the villous axis, or of the bacterial and host factors that account for this distribution. Here, using confocal and intravital two-photon microscopy to monitor the localization of fluorescently tagged V. cholerae strains, we uncovered unexpected and previously unrecognized features of V. cholerae intestinal colonization. Direct visualization of the pathogen within the intestine revealed that the majority of V. cholerae microcolonies attached to the intestinal epithelium arise from single cells, and that there are notable regiospecific aspects to V. cholerae localization and factors required for colonization. In the proximal SI, V. cholerae reside exclusively within the developing intestinal crypts, but they are not restricted to the crypts in the more distal SI. Unexpectedly, V. cholerae motility proved to be a regiospecific colonization factor that is critical for colonization of the proximal, but not the distal, SI. Furthermore, neither motility nor chemotaxis were required for proper V. cholerae distribution along the villous axis or in crypts, suggesting that yet undefined processes enable the pathogen to find its niches outside the intestinal lumen. Finally, our observations suggest that host mucins are a key factor limiting V. cholerae intestinal colonization, particularly in the proximal SI where there appears to be a more abundant mucus layer. Collectively, our findings demonstrate the potent capacity of direct pathogen visualization during infection to deepen our understanding of host pathogen interactions. PMID:25275396

Would you admit your mother to the residency service? Introducing the JCHIMP resident safety column.

PubMed

Foster, Paul N

2014-01-01

There remain tremendous opportunities to improve the stability and safety of American health care. Within this context, residents and residency programs face two essential questions: how to reduce the risk to patients resulting from resident inexperience, and how to change our programs to create the safer physician of the future? The spread of side-by-side teaching and non-teaching services creates a natural setting to study these questions and improve both services. When asked the question, "Would you admit your mother to the resident service?", many of us respond, "It depends". We are focusing this column on helping programs answer this question definitively in the positive, share potential best practices, and underscore community hospital's contribution to our understanding of patient safety.

How do residents manage personal finances?

PubMed

Teichman, Joel M H; Cecconi, Patricia P; Bernheim, B Douglas; Novarro, Neva K; Monga, Manoj; DaRosa, Debra; Resnick, Martin I

2005-02-01

We examined three research questions: How do residents' debts and savings compare to the general public? How do surgical residents' financial choices compare to other residents? How may institutions help residents' personal financial decisions? The Survey of Consumer Finances was modified and piloted tested to elicit financial information. The instrument was completed by 612 residents at 8 programs. Only 60% of residents budgeted expenses, and 25% and 10% maintained cash balances <611 dollars and unpaid credit card balances >10,000 dollars, respectively. Compared with controls, residents held greater median ratios of debt to household income (2.46 vs. 1.06, P <0.0001), fewer assets to income (0.64 vs. 2.28, P <0.0001), less net wealth to income -1.43 vs. 0.90, P <0.0001), and lower retirement savings balance to household income (0.01 vs. 0.12, P <0.0001). Surgery residents were the least financially conservative group. Mean annual resident contributions to retirement accounts were $1532 higher at institutions with versus without retirement plans (P <0.01). Resident debts are higher and savings lower than the general public. This behavior is most common among surgery residents. Residents save more for retirement when they are eligible for tax-deferred retirement plans. Graduate medical programs should instruct residents on financial management.

Video Coaching as an Efficient Teaching Method for Surgical Residents-A Randomized Controlled Trial.

PubMed

Soucisse, Mikael L; Boulva, Kerianne; Sideris, Lucas; Drolet, Pierre; Morin, Michel; Dubé, Pierre

As surgical training is evolving and operative exposure is decreasing, new, effective, and experiential learning methods are needed to ensure surgical competency and patient safety. Video coaching is an emerging concept in surgery that needs further investigation. In this randomized controlled trial conducted at a single teaching hospital, participating residents were filmed performing a side-to-side intestinal anastomosis on cadaveric dog bowel for baseline assessment. The Surgical Video Coaching (SVC) group then participated in a one-on-one video playback coaching and debriefing session with a surgeon, during which constructive feedback was given. The control group went on with their normal clinical duties without coaching or debriefing. All participants were filmed making a second intestinal anastomosis. This was compared to their first anastomosis using a 7-category-validated technical skill global rating scale, the Objective Structured Assessment of Technical Skills. A single independent surgeon who did not participate in coaching or debriefing to the SVC group reviewed all videos. A satisfaction survey was then sent to the residents in the coaching group. Department of Surgery, HôpitalMaisonneuve-Rosemont, tertiary teaching hospital affiliated to the University of Montreal, Canada. General surgery residents from University of Montreal were recruited to take part in this trial. A total of 28 residents were randomized and completed the study. After intervention, the SVC group (n = 14) significantly increased their Objective Structured Assessment of Technical Skills score (mean of differences 3.36, [1.09-5.63], p = 0.007) when compared to the control group (n = 14) (mean of differences 0.29, p = 0.759). All residents agreed or strongly agreed that video coaching was a time-efficient teaching method. Video coaching is an effective and efficient teaching intervention to improve surgical residents' technical skills. Crown Copyright © 2017. Published by Elsevier

Neuroimmune interactions: potential target for mitigating or treating intestinal radiation injury.

PubMed

Wang, J; Hauer-Jensen, M

2007-09-01

Intestinal radiation injury is characterized by breakdown of the epithelial barrier and mucosal inflammation. In addition to replicative and apoptotic cell death, radiation also induces changes in cellular function, as well as alterations secondary to tissue injury. The recognition of these "non-cytocidal" radiation effects has enhanced the understanding of normal tissue radiation toxicity, thus allowing an integrated systems biology-based approach to modulating radiation responses and providing a mechanistic rationale for interventions to mitigate or treat radiation injuries. The enteric nervous system regulates intestinal motility, blood flow and enterocyte function. The enteric nervous system also plays a central role in maintaining the physiological state of the intestinal mucosa and in coordinating inflammatory and fibroproliferative processes. The afferent component of the enteric nervous system, in addition to relaying sensory information, also exerts important effector functions and contributes critically to preserving mucosal integrity. Interactions between afferent nerves, mast cells as well as other cells of the resident mucosal immune system serve to maintain mucosal homeostasis and to ensure an appropriate response to injury. Notably, enteric sensory neurons regulate the activation threshold of mast cells by secreting substance P, calcitonin gene-related peptide and other neuropeptides, whereas mast cells signal to enteric nerves by the release of histamine, nerve growth factor and other mediators. This article reviews how enteric neurons interact with mast cells and other immune cells to regulate the intestinal radiation response and how these interactions may be modified to mitigate intestinal radiation toxicity. These data are not only applicable to radiation therapy, but also to intestinal injury in a radiological terrorism scenario.

Alcoholics Anonymous and other mutual help organizations: Impact of a 45-minute didactic for primary care and categorical internal medicine residents.

PubMed

Marcovitz, David; Cristello, Julie V; Kelly, John F

2017-01-01

Substance use disorders (SUDs) are highly prevalent among primary care patients. One evidence-based, cost-effective referral option is ubiquitous mutual help organizations (MHOs) such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and SMART Recovery; however, little is known about how to effectively increase trainee knowledge and confidence with these referrals. The primary aim of this study was to evaluate whether a single 45-minute combined lecture and role play-based didactic for primary care residents could enhance knowledge, improve attitudes, and bolster confidence in referring patients with addictions to community MHOs. The authors developed a 45-minute lecture and role play addressing the evidence for MHOs, their respective background/content, and how to make effective referrals. Participants were administered a brief survey of their MHO-related knowledge, attitudes, and confidence before and after the session to evaluate the didactic impact. Participants were 55 primary care and categorical internal medicine residents divided among postgraduate year 1 (PGY1; 27.3%), PGY2 (38.2%), and PGY3 (34.5%). They had a mean age of 29 (SD = 2.62); 49% were female, 69% were Caucasian, and 78% reported some religious affiliation. Participants' subjective knowledge about MHOs increased significantly (P < .001), as did their confidence in making referrals (P < .001). Changes in participants' attitudes about the importance of MHOs in aiding successful addiction recovery approached significance (P = .058). The proportion of participants with correct responses to each of 4 knowledge-based questions increased substantially. Primary care and internal medicine residents reported variable baseline knowledge of MHOs and confidence in making referrals, both of which were improved in response to a 45-minute didactic. Role play may be a useful supplementary tool in enhancing residents' knowledge and skill in treating patients with SUD.

Intestinal epithelial cell-specific RARα depletion results in aberrant epithelial cell homeostasis and underdeveloped immune system.

PubMed

Jijon, H B; Suarez-Lopez, L; Diaz, O E; Das, S; De Calisto, J; Yaffe, M B; Pittet, M J; Mora, J R; Belkaid, Y; Xavier, R J; Villablanca, E J

2018-05-01

Retinoic acid (RA), a dietary vitamin A metabolite, is crucial in maintaining intestinal homeostasis. RA acts on intestinal leukocytes to modulate their lineage commitment and function. Although the role of RA has been characterized in immune cells, whether intestinal epithelial cells (IECs) rely on RA signaling to exert their immune-regulatory function has not been examined. Here we demonstrate that lack of RA receptor α (RARα) signaling in IECs results in deregulated epithelial lineage specification, leading to increased numbers of goblet cells and Paneth cells. Mechanistically, lack of RARα resulted in increased KLF4 + goblet cell precursors in the distal bowel, whereas RA treatment inhibited klf4 expression and goblet cell differentiation in zebrafish. These changes in secretory cells are associated with increased Reg3g, reduced luminal bacterial detection, and an underdeveloped intestinal immune system, as evidenced by an almost complete absence of lymphoid follicles and gut resident mononuclear phagocytes. This underdeveloped intestinal immune system shows a decreased ability to clear infection with Citrobacter rodentium. Collectively, our findings indicate that epithelial cell-intrinsic RARα signaling is critical to the global development of the intestinal immune system.

Coaching for Success: A Residency Search Primer and Update for Preceptors and Faculty

PubMed Central

Adams, Alex J.; Ulbrich, Timothy R.; Soric, Mate M.

2015-01-01

Pharmacy residency programs have become increasingly competitive in recent years, and changes to the residency search and application process have altered the process for matching with a residency. In this article, major residency topics, from the benefits of residency training to searching for and ranking programs, are summarized. A discussion of tips and tricks for applying for residencies and interviewing for positions is included along with specific suggestions developed with data following the implementation of the Pharmacy Online Residency Centralized Application Service (PhORCAS). The article is organized in a question and answer format to help facilitate understanding of key concepts and common questions that may arise from applicants. Many changes have taken place in the residency search and application process in recent years, and the process of obtaining a residency is complex. Residency applicants and those advising applicants may find value in the answers to commonly asked residency application questions to help ensure the greatest chance of a successful residency match. PMID:26405338

Medication Refusal: Resident Rights, Administration Dilemma.

PubMed

Haskins, Danielle R; Wick, Jeannette Y

2017-12-01

Occasionally, residents actively or passively refuse to take medications. Residents may refuse medication for a number of reasons, including religious beliefs, dietary restrictions, misunderstandings, cognitive impairment, desire to self-harm, or simple inconvenience. This action creates a unique situation for pharmacists and long-term facility staff, especially if patients have dementia. Residents have the legal right to refuse medications, and long-term care facilities need to employ a process to resolve disagreement between the health care team that recommends the medication and the resident who refuses it. In some cases, simple interventions like selecting a different medication or scheduling medications in a different time can address and resolve the resident's objection. If the medical team and the resident cannot resolve their disagreement, often an ethics consultation is helpful. Documenting the resident's refusal to take any or all medications, the health care team's actions and any other outcomes are important. Residents' beliefs may change over time, and the health care team needs to be prepared to revisit the issue as necessary.

Creating objective and measurable postgraduate year 1 residency graduation requirements.

PubMed

Starosta, Kaitlin; Davis, Susan L; Kenney, Rachel M; Peters, Michael; To, Long; Kalus, James S

2017-03-15

The process of developing objective and measurable postgraduate year 1 (PGY1) residency graduation requirements and a progress tracking system is described. The PGY1 residency accreditation standard requires that programs establish criteria that must be met by residents for successful completion of the program (i.e., graduation requirements), which should presumably be aligned with helping residents to achieve the purpose of residency training. In addition, programs must track a resident's progress toward fulfillment of residency goals and objectives. Defining graduation requirements and establishing the process for tracking residents' progress are left up to the discretion of the residency program. To help standardize resident performance assessments, leaders of an academic medical center-based PGY1 residency program developed graduation requirement criteria that are objective, measurable, and linked back to residency goals and objectives. A system for tracking resident progress relative to quarterly progress targets was instituted. Leaders also developed a focused, on-the-spot skills assessment termed "the Thunderdome," which was designed for objective evaluation of direct patient care skills. Quarterly data on residents' progress are used to update and customize each resident's training plan. Implementation of this system allowed seamless linkage of the training plan, the progress tracking system, and the specified graduation requirement criteria. PGY1 residency requirements that are objective, that are measurable, and that attempt to identify what skills the resident must demonstrate in order to graduate from the program were developed for use in our residency program. A system for tracking the residents' progress by comparing residents' performance to predetermined quarterly benchmarks was developed. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Strategies to accommodate resident work-hour restrictions: impact on surgical education.

PubMed

Freiburg, Carter; James, Ted; Ashikaga, Takamura; Moalem, Jacob; Cherr, Greg

2011-01-01

The introduction of duty-hour restrictions has impacted surgical training. Several strategies were introduced by training programs in response to these restrictions. The purpose of this study was to assess the various strategies employed by residency programs to comply with work-hour restrictions with respect to the impact on the quality of surgical education. A national survey was developed and distributed to resident members of the Resident and Associate Society of the American College of Surgeons in all accredited residency programs across North America. Questions in the survey addressed 10 separate accommodation strategies used by training programs to adhere to resident work-hour restrictions. Resident respondents completed a 5-point Likert scale rating each strategy according to its impact on surgical education (detrimental, not very helpful, neutral, somewhat helpful, and very helpful). A total of 599 (9.7%) responses were received from 6186 members of the Resident Associate Society. The use of health information technology (IT), nurse practitioners, and physician assistants were most highly rated. Hiring clinical fellows, establishing nonteaching services, and shift-work scheduling were the three most poorly rated accommodations to work-hour restrictions with respect to resident education. Hospital IT and nonphysician care providers were rated by residents to optimize surgical education in the current work-hour limitation environment. We infer that strategies which lead to increased efficiency and redistribution of resident workload allow surgical trainees to spend more time on activities perceived to have higher educational value. Copyright © 2011 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

A novel variant of aquaporin 3 is expressed in killifish (Fundulus heteroclitus) intestine

PubMed Central

Jung, Dawoon; Adamo, Meredith A.; Lehman, Rebecca M.; Barnaby, Roxanna; Jackson, Craig E.; Jackson, Brian P.; Shaw, Joseph R.; Stanton, Bruce A.

2015-01-01

Killifish (Fundulus heteroclitus) are euryhaline teleosts that are widely used in environmental and toxicological studies, and they are tolerant to arsenic, in part due to very low assimilation of arsenic from the environment. The mechanism of arsenic uptake by the intestine, a major route of arsenic uptake in humans is unknown. Thus, the goal of this study was to determine if aquaglyceroporins (AQP), which transport water and other small molecules including arsenite across cell membranes, are expressed in the killifish intestine, and whether AQP expression is affected by osmotic stress. Through RT-PCR and sequence analysis of PCR amplicons, we demonstrated that the intestine expresses kfAQP3a and kfAQP3b, two previously identified variants, and also identified a novel variant of killifish AQP3 (kfAQP3c) in the intestine. The variants likely represent alternate splice forms. A BLAST search of the F. heteroclitus reference genome revealed that the AQP3 gene resides on a single locus, while an alignment of the AQP3 sequence among 384 individuals from eight population ranging from Rhode Island to North Carolina revealed that its coding sequence was remarkably conserved with no fixed polymorphism residing in the region that distinguishes these variants. We further demonstrate that the novel variant transports arsenite into HEK293T cells. Whereas kfAQP3a, which does not transport arsenite, was expressed in both freshwater (FW) and saltwater (SW) acclimated fish, kfAQP3b, an arsenic transporter, was expressed only in FW acclimated fish, and kfAQP3c was expressed only in SW acclimated fish. Thus, we have identified a novel, putative splice variant of kfAQP3, kfAQP3c, which transports arsenic and is expressed only in SW acclimated fish. PMID:25766383

Prevalence of intestinal parasitic infections in military personnel and military dogs, Thailand.

PubMed

Leelayoova, Saovanee; Siripattanapipong, Suradej; Naaglor, Tawee; Taamasri, Paanjit; Mungthin, Mathirut

2009-02-01

To determine the prevalence of intestinal parasitic infections and risk factors among military personnel and military dogs at the Military Dog Center, Veterinary and Remount Department, Royal Thai Army, Thailand. A cross-sectional study was conducted in January 2006 to examine intestinal parasitic infections using wet preparation and, formalin-ethyl acetate concentration. Modified acid fast and gram-chromotrope stains were used to identify Cryptosporidium spp. and microsporidia, respectively. Culture for Blastocystis was performed using Jone's medium. Genotypic characterization of Blastocystis and Giardia duodenalis were also determined using PCR-RFLP. To determine the risk factors and outcomes of intestinal parasitic infections, standardized questionnaires were used in the present study. Of 317 military personnel, the prevalence of intestinal parasitic infections was 22.4%. Blastocystis was the most predominant intestinal protozoa infection of 14.5% while G. duodenalis was only 1.3%. The prevalence of other helminthic infections were 4.8% which were Strongyloides stercoralis (2.5%), Hookworm (1.0%), Opisthorchis viverrini (1.0%), and Taenia spp. (0.3%), respectively. Blastocystis subtype 1 was identified in 25 positive culture specimens while all 4 positive of G. duodenalis were analyzed as Assemblage B, subgenotype IV. The presented data could not indicate that intestinal parasitic infections and blastocystosis in this army population were significantly linked to risk association among groups with regard to rank, age group, working unit, area of residence, animal contact, source and treatment of drinking water. Of 189 military dogs, the prevalence of intestinal parasitic infections was only 3.7% which was Blastocystis sp. (2.6%), S. stercoralis (0.5%), and Entamoeba coli (0.5%), respectively. The predominant intestinal parasites found in this population, such as Blastocystis sp. and G duodenalis transmit to humans via fecal-oral route so that improvement of

Some Determinants and Consequences of Helping by the Elderly.

ERIC Educational Resources Information Center

Midlarsky, Elizabeth; Kahana, Eva

Research on helping behavior has focused on help to elderly individuals rather than help by elderly individuals. To investigate the determinants and consequences of helping by older adults, 117 adults, from five Detroit senior citizen residences, with a mean age of 75.6 (67 percent female) completed a personal/demographic questionnaire, including…

Intestinal Cancer

MedlinePlus

... connects your stomach to your large intestine. Intestinal cancer is rare, but eating a high-fat diet ... increase your risk. Possible signs of small intestine cancer include Abdominal pain Weight loss for no reason ...

From Residency to Lifelong Learning.

PubMed

Brandt, Keith

2015-11-01

The residency training experience is the perfect environment for learning. The university/institution patient population provides a never-ending supply of patients with unique management challenges. Resources abound that allow the discovery of knowledge about similar situations. Senior teachers provide counseling and help direct appropriate care. Periodic testing and evaluations identify deficiencies, which can be corrected with future study. What happens, however, when the resident graduates? Do they possess all the knowledge they'll need for the rest of their career? Will medical discovery stand still limiting the need for future study? If initial certification establishes that the physician has the skills and knowledge to function as an independent physician and surgeon, how do we assure the public that plastic surgeons will practice lifelong learning and remain safe throughout their career? Enter Maintenance of Certification (MOC). In an ideal world, MOC would provide many of the same tools as residency training: identification of gaps in knowledge, resources to correct those deficiencies, overall assessment of knowledge, feedback about communication skills and professionalism, and methods to evaluate and improve one's practice. This article discusses the need; for education and self-assessment that extends beyond residency training and a commitment to lifelong learning. The American Board of Plastic Surgery MOC program is described to demonstrate how it helps the diplomate reach the goal of continuous practice improvement.

Ontario Radiation Oncology Residents' Needs in the First Postgraduate Year-Residents' Perspective Survey

DOE Office of Scientific and Technical Information (OSTI.GOV)

Szumacher, Ewa; Warner, Eiran; Zhang Liying

Purpose: To assess radiation oncology residents' needs and satisfaction in their first postgraduate year (PGY-1) in the province of Ontario. Methods and Materials: Of 62 radiation oncology residents, 58 who had completed their PGY-1 and were either enrolled or had graduated in 2006 were invited to participate in a 31-item survey. The questionnaire explored PGY-1 residents' needs and satisfaction in four domains: clinical workload, faculty/learning environment, stress level, and discrimination/harassment. The Fisher's exact and Wilcoxon nonparametric tests were used to determine relationships between covariate items and summary scores. Results: Of 58 eligible residents, 44 (75%) responded. Eighty-four percent of residentsmore » felt that their ward and call duties were appropriate. More than 50% of respondents indicated that they often felt isolated from their radiation oncology program. Only 77% agreed that they received adequate feedback, and 40% received sufficient counseling regarding career planning. More than 93% of respondents thought that faculty members had contributed significantly to their learning experience. Approximately 50% of residents experienced excessive stress and inadequate time for leisure or for reading the medical literature. Less than 10% of residents indicated that they had been harassed or experienced discrimination. Eighty-three percent agreed or strongly agreed that their PGY-1 experience had been outstanding. Conclusions: Most Ontario residents were satisfied with their PGY-1 training program. More counseling by radiation oncology faculty members should be offered to help residents with career planning. The residents might also benefit from more exposure to 'radiation oncology' and an introduction to stress management strategies.« less

Characterization of naturally developing small intestinal bacterial overgrowth in 16 German shepherd dogs.

PubMed

Willard, M D; Simpson, R B; Fossum, T W; Cohen, N D; Delles, E K; Kolp, D L; Carey, D P; Reinhart, G A

1994-04-15

Sixteen German Shepherd Dogs were found, via quantitative microbial culture of intestinal fluid samples, to have small intestinal bacterial overgrowth (IBO) over an 11-month period. All dogs were deficient in serum IgA. Consistent clinical signs suggestive of an alimentary tract disorder were not observed. Serum cobalamin determinations were not helpful in detecting IBO. Serum folate concentrations had variable sensitivity and specificity for detecting dogs from which we could culture > or = 1 x 10(5) bacterial/ml from intestinal fluid samples in the nonfed state. Histologic and intestinal mucosal cytologic examinations were not useful in detecting IBO. Substantial within-dog and between-dog variation was found in the numbers and species of bacteria in the intestines. The difficulty in diagnosing IBO, the variability in organisms found in individual dogs on repeated sampling, the likelihood that intestinal fluid microbial cultures failed to diagnose IBO in some dogs, and the potential of IBO to be clinically inapparent were the most important findings in this study.

Intestinal microbiota, probiotics and mental health: from Metchnikoff to modern advances: Part II – contemporary contextual research

PubMed Central

2013-01-01

In recent years there has been a renewed interest concerning the ways in which the gastrointestinal tract – its functional integrity and microbial residents – might influence human mood (e.g. depression) and behavioral disorders. Once a hotbed of scientific interest in the early 20th century, this area lay dormant for decades, in part due to its association with the controversial term ‘autointoxication’. Here we review contemporary findings related to intestinal permeability, small intestinal bacterial overgrowth, lipopolysaccharide endotoxin (LPS) exposure, D-lactic acid, propionic acid, and discuss their relevance to microbiota and mental health. In addition, we include the context of modern dietary habits as they relate to depression, anxiety and their potential interaction with intestinal microbiota. PMID:23497633

Sleep Practices of University Students Living in Residence

ERIC Educational Resources Information Center

Qin, Pei; Brown, Cary A.

2017-01-01

Sleep plays an important role in both students' academic and personal life. Despite widespread sleep problems among young adults, few studies focus on higher education students living in campus residence. This study investigated residence-living students' sleep patterns, sleep promoting practices, sources of help seeking, and preferred ways to…

Technical skills rotation for general surgery residents.

PubMed

Gonzalez, Ray I; Martinez, Jose M; Iglesias, Alberto R; Lo Menzo, Emanuele; Hutson, Duane; Sleeman, Danny; Livingstone, Alan S; Madan, Atul K

2010-06-15

Technical skills are an important part of any general surgery residency curriculum. With the demands of limited work weeks, it is imperative that educators create novel methods of teaching technical skills to their residents. Our program utilizes a dedicated month to help accomplish this. This study hypothesized that general surgery residents would report a positive effect of a dedicated technical skills rotation. Residents who had undergone a 1 mo rotation in technical skills during their first year were asked to fill out a survey concerning their experience. During the 1-mo rotation, the residents had almost no clinical responsibilities. Teaching of technical skills was performed with various activities, including video content (VC), virtual reality simulators (VR), open foam procedures (OF), laparoscopic box trainers (BT), surgical equipment in-service (SE), and animate sessions (AS). Responses were given on a Likert scale (1-10) with higher numbers being more positive responses. There were seven residents in this study. The residents gave a very positive response to the overall rotation (9.4) and exposure to laparoscopic procedures (9.6). The other responses were enthusiastic as well: exposure to open procedures (8.9) and preparation for operative room (9.4). After their rotation, the residents were comfortable performing a laparoscopic cholecystectomy (9.2), a hand-sewn anastomosis (8.7), and a stapled anastomosis (9.4). The residents found theses activities helpful in increasing order: VC (7.8), VR (8.0), BT (9.0), ES (9.7), OF (9.8), and AS (9.8). A 1-mo dedicated technical skills rotations was perceived to be extremely positive by the residents. The residents felt very comfortable performing a laparoscopic cholecystectomy, a hand-sewn anastomosis, and a stapled anastomosis. With the 80-h work week, alternatives to learning technical skills in the operating room are essential. Further studies need to be performed to determine if this rotation aids in

Alcohol, Intestinal Bacterial Growth, Intestinal Permeability to Endotoxin, and Medical Consequences

PubMed Central

Purohit, Vishnudutt; Bode, J. Christian; Bode, Christiane; Brenner, David A.; Choudhry, Mashkoor A.; Hamilton, Frank; Kang, Y. James; Keshavarzian, Ali; Rao, Radhakrishna; Sartor, R. Balfour; Swanson, Christine; Turner, Jerrold R.

2008-01-01

This report is a summary of the symposium on Alcohol, Intestinal Bacterial Growth, Intestinal Permeability to Endotoxin, and Medical Consequences, organized by National Institute on Alcohol Abuse and Alcoholism, Office of Dietary Supplements, and National Institute of Diabetes and Digestive and Kidney Diseases of National Institutes of Health in Rockville, Maryland, October 11, 2006. Alcohol exposure can promote the growth of Gram negative bacteria in the intestine which may result in accumulation of endotoxin. In addition, alcohol metabolism by Gram negative bacteria and intestinal epithelial cells can result in accumulation of acetaldehyde, which in turn can increase intestinal permeability to endotoxin by increasing tyrosine phosphorylation of tight junction and adherens junction proteins. Alcohol-induced generation of nitric oxide may also contribute to increased permeability to endotoxin by reacting with tubulin, which may cause damage to microtubule cytoskeleton and subsequent disruption of intestinal barrier function. Increased intestinal permeability can lead to increased transfer of endotoxin from the intestine to the liver and general circulation where endotoxin may trigger inflammatory changes in the liver and other organs. Alcohol may also increase intestinal permeability to peptidoglycan which can initiate inflammatory response in liver and other organs. In addition, acute alcohol exposure may potentiate the effect of burn injury on intestinal bacterial growth and permeability. Decreasing the number of Gram negative bacteria in the intestine can result in decreased production of endotoxin as well as acetaldehyde which is expected to decrease intestinal permeability to endotoxin. In addition, intestinal permeability may be preserved by administering epidermal growth factor, L-glutamine, oats supplementation, or zinc thereby preventing the transfer of endotoxin to the general circulation. Thus reducing the number of intestinal Gram negative bacteria and

Resident Transitions to Assisted Living: A Role for Social Workers

ERIC Educational Resources Information Center

Fields, Noelle LeCrone; Koenig, Terry; Dabelko-Schoeny, Holly

2012-01-01

This study explored key aspects of resident transitions to assisted living (AL), including the frequency and importance of preadmission resident education and the potential role of social workers in this setting. To examine the factors that may help or hinder resident transitions to AL, a written survey was administered to a statewide,…

Microbiota promote secretory cell determination in the intestinal epithelium by modulating host Notch signaling.

PubMed

Troll, Joshua V; Hamilton, M Kristina; Abel, Melissa L; Ganz, Julia; Bates, Jennifer M; Stephens, W Zac; Melancon, Ellie; van der Vaart, Michiel; Meijer, Annemarie H; Distel, Martin; Eisen, Judith S; Guillemin, Karen

2018-02-23

Resident microbes promote many aspects of host development, although the mechanisms by which microbiota influence host tissues remain unclear. We showed previously that the microbiota is required for allocation of appropriate numbers of secretory cells in the zebrafish intestinal epithelium. Because Notch signaling is crucial for secretory fate determination, we conducted epistasis experiments to establish whether the microbiota modulates host Notch signaling. We also investigated whether innate immune signaling transduces microbiota cues via the Myd88 adaptor protein. We provide the first evidence that microbiota-induced, Myd88-dependent signaling inhibits host Notch signaling in the intestinal epithelium, thereby promoting secretory cell fate determination. These results connect microbiota activity via innate immune signaling to the Notch pathway, which also plays crucial roles in intestinal homeostasis throughout life and when impaired can result in chronic inflammation and cancer. © 2018. Published by The Company of Biologists Ltd.

Pregnane X receptor agonists enhance intestinal epithelial wound healing and repair of the intestinal barrier following the induction of experimental colitis.

PubMed

Terc, Joshua; Hansen, Ashleigh; Alston, Laurie; Hirota, Simon A

2014-05-13

The intestinal epithelial barrier plays a key role in the maintenance of homeostasis within the gastrointestinal tract. Barrier dysfunction leading to increased epithelial permeability is associated with a number of gastrointestinal disorders including the inflammatory bowel diseases (IBD) - Crohn's disease and ulcerative colitis. It is thought that the increased permeability in patients with IBD may be driven by alterations in the epithelial wound healing response. To this end considerable study has been undertaken to identify signaling pathways that may accelerate intestinal epithelial wound healing and normalize the barrier dysfunction observed in IBD. In the current study we examined the role of the pregnane X receptor (PXR) in modulating the intestinal epithelial wound healing response. Mutations and reduced mucosal expression of the PXR are associated with IBD, and others have reported that PXR agonists can dampen intestinal inflammation. Furthermore, stimulation of the PXR has been associated with increased cell migration and proliferation, two of the key processes involved in wound healing. We hypothesized that PXR agonists would enhance intestinal epithelial repair. Stimulation of Caco-2 intestinal epithelial cells with rifaximin, rifampicin and SR12813, all potent agonists of the PXR, significantly increased wound closure. This effect was driven by p38 MAP kinase-dependent cell migration, and occurred in the absence of cell proliferation. Treating mice with a rodent specific PXR agonist, pregnenolone 16α-carbonitrile (PCN), attenuated the intestinal barrier dysfunction observed in the dextran sulphate sodium (DSS) model of experimental colitis, an effect that occurred independent of the known anti-inflammatory effects of PCN. Taken together our data indicate that the activation of the PXR can enhance intestinal epithelial repair and suggest that targeting the PXR may help to normalize intestinal barrier dysfunction observed in patients with IBD

[Residency in family medicine: problems and solutions].

PubMed

Boulé, Richard; Girard, Gilles

2003-04-01

To identify the problems encountered by residents during training and the solutions they proposed. Qualitative study. Family practice program at Sherbrooke University. Sixty-eight residents in the Family practice program between 1999 and 2000. We used the nominal group technique with four groups of participants. Then we held five 3-hour discussion groups to explore difficulties and solutions in depth. Finally, data were validated with a written questionnaire. At least 20% of respondents confirmed 65 difficulties and 61 solutions. Three major themes emerged: the many demands of the residence program, residents' personal experience of the program, and the lack of time for personal life. Publication of these results could help residents develop proactive adaptive strategies to deal with the stress of their training programs. Certain adjustments will be made by the program administration to make it easier for residents to manage their stress.

An endogenous nanomineral chaperones luminal antigen and peptidoglycan to intestinal immune cells

NASA Astrophysics Data System (ADS)

Powell, Jonathan J.; Thomas-McKay, Emma; Thoree, Vinay; Robertson, Jack; Hewitt, Rachel E.; Skepper, Jeremy N.; Brown, Andy; Hernandez-Garrido, Juan Carlos; Midgley, Paul A.; Gomez-Morilla, Inmaculada; Grime, Geoffrey W.; Kirkby, Karen J.; Mabbott, Neil A.; Donaldson, David S.; Williams, Ifor R.; Rios, Daniel; Girardin, Stephen E.; Haas, Carolin T.; Bruggraber, Sylvaine F. A.; Laman, Jon D.; Tanriver, Yakup; Lombardi, Giovanna; Lechler, Robert; Thompson, Richard P. H.; Pele, Laetitia C.

2015-05-01

In humans and other mammals it is known that calcium and phosphate ions are secreted from the distal small intestine into the lumen. However, why this secretion occurs is unclear. Here, we show that the process leads to the formation of amorphous magnesium-substituted calcium phosphate nanoparticles that trap soluble macromolecules, such as bacterial peptidoglycan and orally fed protein antigens, in the lumen and transport them to immune cells of the intestinal tissue. The macromolecule-containing nanoparticles utilize epithelial M cells to enter Peyer's patches, small areas of the intestine concentrated with particle-scavenging immune cells. In wild-type mice, intestinal immune cells containing these naturally formed nanoparticles expressed the immune tolerance-associated molecule ‘programmed death-ligand 1’, whereas in NOD1/2 double knockout mice, which cannot recognize peptidoglycan, programmed death-ligand 1 was undetected. Our results explain a role for constitutively formed calcium phosphate nanoparticles in the gut lumen and show how this helps to shape intestinal immune homeostasis.

Resident Role Modeling: "It Just Happens".

PubMed

Sternszus, Robert; Macdonald, Mary Ellen; Steinert, Yvonne

2016-03-01

Role modeling by staff physicians is a significant component of the clinical teaching of students and residents. However, the importance of resident role modeling has only recently emerged, and residents' understanding of themselves as role models has yet to be explored. This study sought to understand residents' perceptions of themselves as role models, describe how residents learn about role modeling, and identify ways to improve resident role modeling. Fourteen semistructured interviews were conducted with residents in internal medicine, general surgery, and pediatrics at the McGill University Faculty of Medicine between April and September 2013. Interviews were audio-recorded and subsequently transcribed for analysis; iterative analysis followed principles of qualitative description. Four primary themes were identified through data analysis: residents perceived role modeling as the demonstration of "good" behaviors in the clinical context; residents believed that learning from their role modeling "just happens" as long as learners are "watching"; residents did not equate role modeling with being a role model; and residents learned about role modeling from watching their positive and negative role models. While residents were aware that students and junior colleagues learned from their modeling, they were often not aware of role modeling as it was occurring; they also believed that learning from role modeling "just happens" and did not always see themselves as role models. Helping residents view effective role modeling as a deliberate process rather than something that "just happens" may improve clinical teaching across the continuum of medical education.

Synoptic philosophy in a neurosurgical residency: a book and cinema club.

PubMed

Wadhwa, Rishi; Thakur, Jai Deep; Cardenas, Raul; Wright, Jeri; Nanda, Anil

2013-11-01

Introduction of a book and cinema club in a Department of Neurosurgery has helped combine an education in humanities with neurosurgical training. The authors believe the addition of teaching in humanities adds to the specialty and helps in fulfilling the six core competencies of the Accreditation Council for Graduate Medical Education. The goal is to encourage synoptic philosophy and impart creative ways of interacting with the world. Books and movies with a medical basis and nonmedical basis were selected and reviewed in an open forum. Efforts were made to integrate the Accreditation Council for Graduate Medical Education six core competencies into the discussions. Residents anonymously completed a questionnaire pertaining to the usefulness of the book club in residency. There were 13 residents who attended the sessions and responded to the questionnaire. Of residents, 61.5% believed the topics were pertinent to their everyday life, and 77% believed that the club had helped them somehow in residency. Most (7 of 13) believed the club should not be included as part of the curriculum in an 80-hour work week. Institution of a book and movie club seems to be an effective way of integrating humanities within a neurosurgical residency. Published by Elsevier Inc.

Assessment of the Effect of Intestinal Permeability Probes (Lactulose And Mannitol) and Other Liquids on Digesta Residence Times in Various Segments of the Gut Determined by Wireless Motility Capsule: A Randomised Controlled Trial.

PubMed

Sequeira, Ivana R; Lentle, Roger G; Kruger, Marlena C; Hurst, Roger D

2015-01-01

Whilst the use of the mannitol/lactulose test for intestinal permeability has been long established it is not known whether the doses of these sugars modify transit time Similarly it is not known whether substances such as aspirin that are known to increase intestinal permeability to lactulose and mannitol and those such as ascorbic acid which are stated to be beneficial to gastrointestinal health also influence intestinal transit time. Gastric and intestinal transit times were determined with a SmartPill following consumption of either a lactulose mannitol solution, a solution containing 600 mg aspirin, a solution containing 500 mg of ascorbic acid or an extract of blackcurrant, and compared by doubly repeated measures ANOVA with those following consumption of the same volume of a control in a cross-over study in six healthy female volunteers. The dominant frequencies of cyclic variations in gastric pressure recorded by the Smartpill were determined by fast Fourier transforms. The gastric transit times of lactulose mannitol solutions, of aspirin solutions and of blackcurrant juice did not differ from those of the control. The gastric transit times of the ascorbic acid solutions were significantly shorter than those of the other solutions. There were no significant differences between the various solutions either in the total small intestinal or colonic transit times. The intraluminal pHs during the initial quartiles of the small intestinal transit times were lower than those in the succeeding quartiles. This pattern did not vary with the solution that was consumed. The power of the frequencies of cyclic variation in intragastric pressure recorded by the Smartpill declined exponentially with increase in frequency and did not peak at the reported physiological frequencies of gastric contractile activity. Whilst the segmental residence times were broadly similar to those using other methods, the high degree of variation between subjects generally precluded the

EPA Grant will help Berkshire County Residents with Energy Efficiency and Air Quality

EPA Pesticide Factsheets

A project that works to reduce respiratory health problems for residents in northern Berkshire County of Massachusetts through energy efficiency improvements, has received $25,000 from a US Environmental Protection Agency program that addresses environment

Absorption sites of orally administered drugs in the small intestine.

PubMed

Murakami, Teruo

2017-12-01

In pharmacotherapy, drugs are mostly taken orally to be absorbed systemically from the small intestine, and some drugs are known to have preferential absorption sites in the small intestine. It would therefore be valuable to know the absorption sites of orally administered drugs and the influencing factors. Areas covered:In this review, the author summarizes the reported absorption sites of orally administered drugs, as well as, influencing factors and experimental techniques. Information on the main absorption sites and influencing factors can help to develop ideal drug delivery systems and more effective pharmacotherapies. Expert opinion: Various factors including: the solubility, lipophilicity, luminal concentration, pKa value, transporter substrate specificity, transporter expression, luminal fluid pH, gastrointestinal transit time, and intestinal metabolism determine the site-dependent intestinal absorption. However, most of the dissolved fraction of orally administered drugs including substrates for ABC and SLC transporters, except for some weakly basic drugs with higher pKa values, are considered to be absorbed sequentially from the proximal small intestine. Securing the solubility and stability of drugs prior to reaching to the main absorption sites and appropriate delivery rates of drugs at absorption sites are important goals for achieving effective pharmacotherapy.

Functional relevance of intestinal epithelial cells in inflammatory bowel disease.

PubMed

Okamoto, Ryuichi; Watanabe, Mamoru

2016-01-01

The intestinal epithelium constitutes a physical barrier between inner and outer side of our body. It also functions as a "hub" which connects factors that determine the development of inflammatory bowel disease, such as microbiota, susceptibility genes, and host immune response. Accordingly, recent studies have implicated and further featured the role of intestinal epithelial cell dysfunction in the pathophysiology of inflammatory bowel disease. For example, mucin producing goblet cells are usually "depleted" in ulcerative colitis patients. Studies have shown that those goblet cells exhibit various immune-regulatory functions in addition to mucin production, such as antigen presentation or cytokine production. Paneth cells are another key cell lineage that has been deeply implicated in the pathophysiology of Crohn's disease. Several susceptibility genes for Crohn's disease may lead to impairment of anti-bacterial peptide production and secretion by Paneth cells. Also, other susceptibility genes may determine the survival of Paneth cells, which leads to reduced Paneth cell function in the patient small intestinal mucosa. Further studies may reveal other unexpected roles of the intestinal epithelium in the pathophysiology of inflammatory bowel disease, and may help to develop alternative therapies targeted to intestinal epithelial cell functions.

Beneficial effects of naloxone in a patient with intestinal pseudoobstruction

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schang, J.C.; Devroede, G.

1985-06-01

A 15-day course of Naloxone treatment was given to a patient with intestinal pseudoobstruction who had previously undergone subtotal colectomy with terminal ileostomy for invalidating constipation. The effects of the drug were assessed according to symptoms, by recording the myoelectric activity of the stomach, and by measuring gastric emptying of a radiolabeled solid-liquid meal and the intestinal transit time of radiopaque markers. All tests were performed 1) at baseline; 2) after 2 wk with Naloxone 1.6 mg subcutaneous per day; and 3) after 8 days of placebo. Results showed that before treatment gastric emptying of solids was delayed, emptying ofmore » liquids was normal, myoelectric activity of the stomach was normal, small intestinal transit time of radiopaque markers was considerably increased while ileal output was markedly decreased. After Naloxone, gastric emptying of solids was markedly accelerated, emptying of liquids remained normal, gastric electrical spiking activity increased, small intestinal transit time strikingly decreased, and ileal output increased. After placebo, a tendency to return to pretreatment values was observed. This observation suggests that Naloxone may be helpful in the treatment of some patients with intestinal pseudoobstruction.« less

Residents' Perceptions of Classroom Situated E-Learning for Medical Education

ERIC Educational Resources Information Center

Segerman, Jill

2013-01-01

Medical education helps ensure doctors acquire skills and knowledge needed to care for patients. However, resident duty hour restrictions have impacted time residents have for medical education, leaving resident educators searching for innovative options for effective medical education. Classroom situated e-learning, a blended learning delivery…

Resident Preferences for Program Director Role in Wellness Management.

PubMed

Kolarik, Russ C; O'Neal, Richard L; Ewing, Joseph A

2018-05-01

Burnout and depression are prevalent among resident physicians, though the supportive role of the program director (PD) is not well defined. To understand the residents' view of the residency program director's role in assessing and promoting resident wellness. A single institution survey of all house staff was conducted in 2017. Rates of burnout and depression were identified via the 2-item Maslach Burnout Inventory (MBI) and the Patient Health Questionaire-2 (PHQ-2), respectively. Residents then qualified their preferences for various assistance services and for the role of their program directors in assisting them. One-hundred sixty-one of 202 (79.7%) residents completed the survey. The rate of depression was 28%. Rates of emotional exhaustion and depersonalization (2-item MBI) were 44 and 62%, respectively. Only 4% of respondents had used the Employee Assistance Program (EAP) in the prior 12 months. Eighty-two percent of residents were in favor of PDs inquiring about wellness regardless of their job performance and only 1% of residents stated the PD should not inquire about wellness at all. Thirty-three percent of residents reported that they would be likely to contact EAP on their own if they felt unwell. Significantly more residents (62%) reported being more likely to contact EAP if recommended by their PD (33 vs 62%, p < 0.001%). Important perceived barriers to seeking assistance were lack of time (65%), lack of knowledge of how to contact EAP (41%), and concerns about appearing weak (35%). Despite a high prevalence of burnout and depression, residents are unlikely to seek help on their own. Program directors have an important role in assessing and promoting the wellness of their residents. The majority of residents wants their PD to inquire about wellness and may be more likely to seek and receive help if recommended and facilitated by their PD.

Implementing Competency-Based Medical Education in a Postgraduate Family Medicine Residency Training Program: A Stepwise Approach, Facilitating Factors, and Processes or Steps That Would Have Been Helpful.

PubMed

Schultz, Karen; Griffiths, Jane

2016-05-01

In 2009-2010, the postgraduate residency training program at the Department of Family Medicine, Queen's University, wrestled with the practicalities of competency-based medical education (CBME) implementation when its accrediting body, the College of Family Physicians of Canada, introduced the competency-based Triple C curriculum. The authors used a stepwise approach to implement CMBE; the steps were to (1) identify objectives, (2) identify competencies, (3) map objectives and competencies to learning experiences and assessment processes, (4) plan learning experiences, (5) develop an assessment system, (6) collect and interpret data, (7) adjust individual residents' training programs, and (8) distribute decisions to stakeholders. The authors also note overarching processes, costs, and facil itating factors and processes or steps that would have been helpful for CBME implementation. Early outcomes are encouraging. Residents are being directly observed more often with increased documented feedback about performance based on explicit competency standards (24,000 data points for 150 residents from 2013 to 2015). These multiple observations are being collated in a way that is allowing the identification of patterns of performance, red flags, and competency development trajectory. Outliers are being identified earlier, resulting in earlier individualized modification of their residency training program. The authors will continue to provide and refine faculty development, are developing an entrustable professional activity field note app for handheld devices, and are undertaking research to explore what facilitates learners' competency development, what increases assessors' confidence in making competence decisions, and whether residents are better trained as a result of CBME implementation.

Intestinal parasitosis and anaemia among patients in a Health Center, North Ethiopia.

PubMed

Alemu, Megbaru; Kinfe, Birhane; Tadesse, Desalegn; Mulu, Wondemagegn; Hailu, Tadesse; Yizengaw, Endalew

2017-11-28

The aim of this cross-sectional study was to determine the magnitude of intestinal parasitosis and anaemia in a Health Center, North Ethiopia. A total of 427 outpatients were enrolled and the median age of the participants was 22 years. The prevalence of intestinal parasitosis was 143 (33.5%). Age, place of residence and occupation were significantly associated with intestinal parasitosis. When we see parasite specific factors, significant associations were observed for source of drinking water (P = 0.02), age (P < 0.001) and family size (P = 0.003), respectively with Entameba histolytica, Hookworm and Giardia lamblia infections. The overall prevalence of anaemia was 35 (8.2%). The mean haemoglobin concentration among the study participants was 12.8 mg/dl. The highest prevalence of anemia was recorded for the age group of 15-19 years (29.6%). The proportion of anemia among intestinal parasite -infected and non-infected participants was 10.7 and 7.0%, respectively. Study participants infected with S. stercoralis and hookworm were more likely to develop anaemia than the non- infected ones; AOR (adjusted odds ratio) = 5.3, 95% CI (1.01-27.4); P = 0.028 and AOR = 11.1, 95% CI (3.36-36.9); P = 0.000, respectively.

Intestinal barrier: A gentlemen’s agreement between microbiota and immunity

PubMed Central

Caricilli, Andrea Moro; Castoldi, Angela; Câmara, Niels Olsen Saraiva

2014-01-01

Our body is colonized by more than a hundred trillion commensals, represented by viruses, bacteria and fungi. This complex interaction has shown that the microbiome system contributes to the host’s adaptation to its environment, providing genes and functionality that give flexibility of diet and modulate the immune system in order not to reject these symbionts. In the intestine, specifically, the microbiota helps developing organ structures, participates of the metabolism of nutrients and induces immunity. Certain components of the microbiota have been shown to trigger inflammatory responses, whereas others, anti-inflammatory responses. The diversity and the composition of the microbiota, thus, play a key role in the maintenance of intestinal homeostasis and explain partially the link between intestinal microbiota changes and gut-related disorders in humans. Tight junction proteins are key molecules for determination of the paracellular permeability. In the context of intestinal inflammatory diseases, the intestinal barrier is compromised, and decreased expression and differential distribution of tight junction proteins is observed. It is still unclear what is the nature of the luminal or mucosal factors that affect the tight junction proteins function, but the modulation of the immune cells found in the intestinal lamina propria is hypothesized as having a role in this modulation. In this review, we provide an overview of the current understanding of the interaction of the gut microbiota with the immune system in the development and maintenance of the intestinal barrier. PMID:24891972

Resident health advocates in public housing family developments.

PubMed

Bowen, Deborah J; Bhosrekar, Sarah Gees; Rorie, Jo-Anna; Goodman, Rachel; Thomas, Gerry; Maxwell, Nancy Irwin; Smith, Eugenia

2015-01-01

Translation of research to practice often needs intermediaries to help the process occur. Our Prevention Research Center has identified a total of 89 residents of public housing in the last 11 years who have been working in the Resident Health Advocate (RHA) program to engage residents in improving their own and other residents' health status by becoming trained in skills needed by community health workers. Future directions include training for teens to become Teen RHAs and further integration of our RHA program with changes in the health care system and in the roles of community health workers in general.

Contrasting Ecological Processes and Functional Compositions Between Intestinal Bacterial Community in Healthy and Diseased Shrimp.

PubMed

Zhu, Jinyong; Dai, Wenfang; Qiu, Qiongfen; Dong, Chunming; Zhang, Jinjie; Xiong, Jinbo

2016-11-01

Intestinal bacterial communities play a pivotal role in promoting host health; therefore, the disruption of intestinal bacterial homeostasis could result in disease. However, the effect of the occurrences of disease on intestinal bacterial community assembly remains unclear. To address this gap, we compared the multifaceted ecological differences in maintaining intestinal bacterial community assembly between healthy and diseased shrimps. The neutral model analysis shows that the relative importance of neutral processes decreases when disease occurs. This pattern is further corroborated by the ecosphere null model, revealing that the bacterial community assembly of diseased samples is dominated by stochastic processes. In addition, the occurrence of shrimp disease reduces the complexity and cooperative activities of species-to-species interactions. The keystone taxa affiliated with Alphaproteobacteria and Actinobacteria in healthy shrimp gut shift to Gammaproteobacteria species in diseased shrimp. Changes in intestinal bacterial communities significantly alter biological functions in shrimp. Within a given metabolic pathway, the pattern of enrichment or decrease between healthy and deceased shrimp is correlated with its functional effects. We propose that stressed shrimp are more prone to invasion by alien strains (evidenced by more stochastic assembly and higher migration rate in diseased shrimp), which, in turn, disrupts the cooperative activity among resident species. These findings greatly aid our understanding of the underlying mechanisms that govern shrimp intestinal community assembly between health statuses.

Prom1 Function in Development, Intestinal Inflammation, and Intestinal Tumorigenesis

PubMed Central

Karim, Baktiar O.; Rhee, Ki-Jong; Liu, Guosheng; Yun, Kyuson; Brant, Steven R.

2014-01-01

Prom1/CD133 has been identified in colorectal, hepatocellular, and pancreatic cancer as a cancer stem cell marker and has been used as such to predict colon cancer recurrence in humans. Its potential molecular function as well as its role as a marker of intestinal regeneration is still not fully known. We evaluated the role of Prom1 in intestinal regeneration in inflammatory bowel disease (IBD), determined the function of Prom1, and characterized the effect of a lack of Prom1 on intestinal tumor formation in animal models. Our results suggest that Apc mutations lead to an increase in Prom1 expressing cells in the intestinal crypt stem cell compartment and in early intestinal adenomas. Also, Prom1 knockout mice are more susceptible to intestinal tumor formation. We conclude that Prom1 likely plays a role in regulating intestinal homeostasis and that these results clearly illustrate the role of Prom1 in intestinal regeneration. We further conclude that Prom1 may provide a novel therapeutic target for patients with gastrointestinal conditions such as IBD, short bowel syndrome, and colorectal cancer. PMID:25452936

Validation of the Visitor and Resident Framework in an E-Book Setting

ERIC Educational Resources Information Center

Engelsmann, Hazel C.; Greifeneder, Elke; Lauridsen, Nikoline D.; Nielsen, Anja G.

2014-01-01

Introduction: By applying the visitor and resident framework on e-book usage, the article explores whether the concepts of a resident and a visitor can help to explain e-book use, and can help to gain a better insight into users' motivations for e-book use. Method: A questionnaire and semi-structured interviews were conducted with users of the…

Migration of Drosophila intestinal stem cells across organ boundaries

PubMed Central

Takashima, Shigeo; Paul, Manash; Aghajanian, Patrick; Younossi-Hartenstein, Amelia; Hartenstein, Volker

2013-01-01

All components of the Drosophila intestinal tract, including the endodermal midgut and ectodermal hindgut/Malpighian tubules, maintain populations of dividing stem cells. In the midgut and hindgut, these stem cells originate from within larger populations of intestinal progenitors that proliferate during the larval stage and form the adult intestine during metamorphosis. The origin of stem cells found in the excretory Malpighian tubules (‘renal stem cells’) has not been established. In this paper, we investigate the migration patterns of intestinal progenitors that take place during metamorphosis. Our data demonstrate that a subset of adult midgut progenitors (AMPs) move posteriorly to form the adult ureters and, consecutively, the renal stem cells. Inhibiting cell migration by AMP-directed expression of a dominant-negative form of Rac1 protein results in the absence of stem cells in the Malpighian tubules. As the majority of the hindgut progenitor cells migrate posteriorly and differentiate into hindgut enterocytes, a group of the progenitor cells, unexpectedly, invades anteriorly into the midgut territory. Consequently, these progenitor cells differentiate into midgut enterocytes. The midgut determinant GATAe is required for the differentiation of midgut enterocytes derived from hindgut progenitors. Wingless signaling acts to balance the proportion of hindgut progenitors that differentiate as midgut versus hindgut enterocytes. Our findings indicate that a stable boundary between midgut and hindgut/Malpighian tubules is not established during early embryonic development; instead, pluripotent progenitor populations cross in between these organs in both directions, and are able to adopt the fate of the organ in which they come to reside. PMID:23571215

Small intestinal ischemia and infarction

MedlinePlus

Intestinal necrosis; Ischemic bowel - small intestine; Dead bowel - small intestine; Dead gut - small intestine; Infarcted bowel - small intestine; Atherosclerosis - small intestine; Hardening of the arteries - small intestine

Internal Medicine Residents' Perspectives on Receiving Feedback in Milestone Format

PubMed Central

Angus, Steven; Moriarty, John; Nardino, Robert J.; Chmielewski, Amy; Rosenblum, Michael J.

2015-01-01

Background In contrast to historical feedback, which was vague or provided residents' numerical scores without clear meaning, milestone-based feedback is focused on specific knowledge, skills, and behaviors that define developmental trajectory. It was anticipated that residents would welcome the more specific and actionable feedback provided by the milestone framework, but this has not been studied. Objective We assessed internal medicine (IM) residents' perceptions of receiving feedback in the milestone framework, particularly assessing perception of the utility of milestone-based feedback compared to non–milestone-based feedback. Methods We surveyed a total of 510 IM residents from 7 institutions. Survey questions assessed resident perception of milestone feedback in identifying strengths, weaknesses, and trajectory of professional development. Postgraduate years 2 and 3 (PGY-2 and PGY-3) residents were asked to compare milestones with prior methods of feedback. Results Of 510 residents, 356 (69.8%) responded. Slightly less than half of the residents found milestone-based feedback “extremely useful” or “very useful” in identifying strengths (44%), weaknesses (43%), specific areas for improvement (45%), and appropriate education progress (48%). Few residents found such feedback “not very useful” or “not at all useful” in these domains. A total of 51% of PGY-2 and PGY-3 residents agreed that receiving milestone-based feedback was more helpful than previous forms of feedback. Conclusions IM residents are aware of the concepts of milestones, and half of the residents surveyed found milestone feedback more helpful than previous forms of feedback. More work needs to be done to understand how milestone-based feedback could be delivered more effectively to enhance resident development. PMID:26221438

Protecting Your Residence Hall Furniture Investment.

ERIC Educational Resources Information Center

Wiens, Janet

2003-01-01

Asserting that residence hall furniture takes abuse simply through use, discusses a three-part approach--student involvement and education, creating the right environment, and ongoing maintenance--that helps reduce normal wear and tear. (EV)

Impact of Intestinal Microbiota on Intestinal Luminal Metabolome

PubMed Central

Matsumoto, Mitsuharu; Kibe, Ryoko; Ooga, Takushi; Aiba, Yuji; Kurihara, Shin; Sawaki, Emiko; Koga, Yasuhiro; Benno, Yoshimi

2012-01-01

Low–molecular-weight metabolites produced by intestinal microbiota play a direct role in health and disease. In this study, we analyzed the colonic luminal metabolome using capillary electrophoresis mass spectrometry with time-of-flight (CE-TOFMS) —a novel technique for analyzing and differentially displaying metabolic profiles— in order to clarify the metabolite profiles in the intestinal lumen. CE-TOFMS identified 179 metabolites from the colonic luminal metabolome and 48 metabolites were present in significantly higher concentrations and/or incidence in the germ-free (GF) mice than in the Ex-GF mice (p < 0.05), 77 metabolites were present in significantly lower concentrations and/or incidence in the GF mice than in the Ex-GF mice (p < 0.05), and 56 metabolites showed no differences in the concentration or incidence between GF and Ex-GF mice. These indicate that intestinal microbiota highly influenced the colonic luminal metabolome and a comprehensive understanding of intestinal luminal metabolome is critical for clarifying host-intestinal bacterial interactions. PMID:22724057

Wireless capsule endoscopy for diagnosis of acute intestinal graft-versus-host disease.

PubMed

Neumann, Susanne; Schoppmeyer, Konrad; Lange, Thoralf; Wiedmann, Marcus; Golsong, Johannes; Tannapfel, Andrea; Mossner, Joachim; Niederwieser, Dietger; Caca, Karel

2007-03-01

The small intestine is the most common location of intestinal graft-versus-host disease (GVHD). EGD with duodenal biopsies yields the highest diagnostic sensitivity, but the jejunum and ileum are not accessible by regular endoscopy. In contrast, wireless capsule endoscopy (WCE) is a noninvasive imaging procedure offering complete evaluation of the small intestine. The objective was to compare the diagnostic value of EGD, including biopsies, with the results of WCE in patients with acute intestinal symptoms who received allogeneic blood stem cell transplantation and to analyze the appearance and distribution of acute intestinal GVHD lesions in these patients. An investigator-blinded, single-center prospective study. Patients with acute intestinal symptoms after allogeneic stem cell transplantation underwent both EGD and WCE within 24 hours. Clinical data were recorded during 2 months of follow-up. Fourteen consecutive patients with clinical symptoms of acute intestinal GVHD were recruited. In 1 patient, the capsule remained in the stomach and was removed endoscopically. In 7 of 13 patients who could be evaluated, acute intestinal GVHD was diagnosed by EGD with biopsies, but 3 of these would have been missed by EGD alone. In all 7 patients with histologically confirmed acute intestinal GVHD, WCE revealed typical signs of GVHD. Lesions were scattered throughout the small intestine, but were most accentuated in the ileum. This study had a small number of patients. WCE, which is less invasive than EGD with biopsies, showed a comparable sensitivity and a high negative predictive value for diagnosing acute intestinal GVHD. It may be helpful to avoid repeated endoscopic procedures in patients who have undergone stem cell transplantation.

Imaging diagnosis--muscular hypertrophy of the small intestine and pseudodiverticula in a horse.

PubMed

Navas De Solís, Cristobal; Biscoe, Elisabeth W; Lund, Caleb M; Labbe, Karyn; Muñoz, Juan; Farnsworth, Kelly

2015-01-01

A 14-year-old Thoroughbred gelding was presented for chronic colic and weight loss. Transcutaneous and transrectal abdominal ultrasonography revealed distended, thickened small intestine with primary thickening of the muscularis and a focally more thickened loop with an echoic structure crossing the wall from the mucosa to the serosa. Visualization of diffuse thickening of the muscularis (muscular hypertrophy of the small intestine) and a focal lesion (pseudodiverticulum) helped clinicians make informed decisions. This case illustrates the importance of transabdominal and transrectal ultrasonography in horses with chronic colic and the relevance of considering the abnormalities in layering pattern of the intestinal wall. © 2014 American College of Veterinary Radiology.

A method for the specific detection of resident bacteria in brine shrimp larvae.

PubMed

Niu, Yufeng; Defoirdt, Tom; Rekecki, Anamaria; De Schryver, Peter; Van den Broeck, Wim; Dong, Shuanglin; Sorgeloos, Patrick; Boon, Nico; Bossier, Peter

2012-04-01

In this study, we describe an easy but efficient method to specifically target the intestinal resident microbiota in brine shrimp larvae during DGGE analysis, hereby excluding the interference of both transient (luminal) bacteria and body surface bacteria. This effective technique has several advantages over alternative methods, with respect of ease of use and rapidity. Copyright © 2012 Elsevier B.V. All rights reserved.

An Endogenous Nanomineral Chaperones Luminal Antigen and Peptidoglycan to Intestinal Immune Cells

PubMed Central

Powell, Jonathan J; Thomas-McKay, Emma; Thoree, Vinay; Robertson, Jack; Hewitt, Rachel E; Skepper, Jeremy N; Brown, Andy; Hernandez-Garrido, Juan Carlos; Midgley, Paul A; Gomez-Morilla, Inmaculada; Grime, Geoffrey W; Kirkby, Karen J; Mabbott, Neil A; Donaldson, David S; Williams, Ifor R; Rios, Daniel; Girardin, Stephen E; Haas, Carolin T; Bruggraber, Sylvaine FA; Laman, Jon D; Tanriver, Yakup; Lombardi, Giovanna; Lechler, Robert; Thompson, Richard P H; Pele, Laetitia C

2015-01-01

In humans and other mammals, it is known that calcium and phosphate ions are secreted from the distal small intestine into the lumen. However, why this secretion occurs is unclear. Here, we show that the process leads to the formation of amorphous magnesium-substituted calcium phosphate nanoparticles that trap soluble macromolecules, such as bacterial peptidoglycan and orally-fed protein antigens, in the lumen and transport them to immune cells of the intestinal tissue. The macromolecule-containing nanoparticles utilize epithelial M cells to enter Peyer’s patches - small areas of the intestine concentrated with particle-scavenging immune cells. In wild type mice, intestinal immune cells containing these naturally-formed nanoparticles expressed the immune tolerance-associated molecule ‘programmed death-ligand 1 (PD-L1)’, whereas in NOD1/2 double knock-out mice, which cannot recognize peptidoglycan, PD-L1 was undetected. Our results explain a role for constitutively formed calcium phosphate nanoparticles in the gut lumen and how this helps to shape intestinal immune homeostasis. PMID:25751305

Implementing Proactive Network Management Solutions in the Residence Halls

ERIC Educational Resources Information Center

Bedi, Param

2005-01-01

This paper discusses how to implement networking solutions in residence halls at Arcadia University in Philadelphia. Sections of the paper include: (1) About Arcadia University; (2) Residence Halls Network; (3) How Campus Manager Helped Arcadia University; (4) What Is Campus Manager; (5) How Campus Manager Works; (6) Campus Manager Remediation…

Understanding Public School Residency Requirements: A Guide for Advocates

ERIC Educational Resources Information Center

Education Law Center, 2005

2005-01-01

Parents, guardians, caregivers and school administrators will sometimes disagree over whether a student resides in a school district and can be enrolled in a district public school. The information in this manual is designed to help parents, guardians and caregivers understand the legal concepts involved in residency disputes, and to inform…

An Evidence-based, Longitudinal Curriculum for Resident Physician Wellness: The 2017 Resident Wellness Consensus Summit

PubMed Central

Arnold, Jacob; Tango, Jennifer; Walker, Ian; Waranch, Chris; McKamie, Joshua; Poonja, Zafrina

2018-01-01

Introduction Physicians are at much higher risk for burnout, depression, and suicide than their non-medical peers. One of the working groups from the May 2017 Resident Wellness Consensus Summit (RWCS) addressed this issue through the development of a longitudinal residency curriculum to address resident wellness and burnout. Methods A 30-person (27 residents, three attending physicians) Wellness Curriculum Development workgroup developed the curriculum in two phases. In the first phase, the workgroup worked asynchronously in the Wellness Think Tank – an online resident community – conducting a literature review to identify 10 core topics. In the second phase, the workgroup expanded to include residents outside the Wellness Think Tank at the live RWCS event to identify gaps in the curriculum. This resulted in an additional seven core topics. Results Seventeen foundational topics served as the framework for the longitudinal resident wellness curriculum. The curriculum includes a two-module introduction to wellness; a seven-module “Self-Care Series” focusing on the appropriate structure of wellness activities and everyday necessities that promote physician wellness; a two-module section on physician suicide and self-help; a four-module “Clinical Care Series” focusing on delivering bad news, navigating difficult patient encounters, dealing with difficult consultants and staff members, and debriefing traumatic events in the emergency department; wellness in the workplace; and dealing with medical errors and shame. Conclusion The resident wellness curriculum, derived from an evidence-based approach and input of residents from the Wellness Think Tank and the RWCS event, provides a guiding framework for residency programs in emergency medicine and potentially other specialties to improve physician wellness and promote a culture of wellness. PMID:29560063

An Evidence-based, Longitudinal Curriculum for Resident Physician Wellness: The 2017 Resident Wellness Consensus Summit.

PubMed

Arnold, Jacob; Tango, Jennifer; Walker, Ian; Waranch, Chris; McKamie, Joshua; Poonja, Zafrina; Messman, Anne

2018-03-01

Physicians are at much higher risk for burnout, depression, and suicide than their non-medical peers. One of the working groups from the May 2017 Resident Wellness Consensus Summit (RWCS) addressed this issue through the development of a longitudinal residency curriculum to address resident wellness and burnout. A 30-person (27 residents, three attending physicians) Wellness Curriculum Development workgroup developed the curriculum in two phases. In the first phase, the workgroup worked asynchronously in the Wellness Think Tank - an online resident community - conducting a literature review to identify 10 core topics. In the second phase, the workgroup expanded to include residents outside the Wellness Think Tank at the live RWCS event to identify gaps in the curriculum. This resulted in an additional seven core topics. Seventeen foundational topics served as the framework for the longitudinal resident wellness curriculum. The curriculum includes a two-module introduction to wellness; a seven-module "Self-Care Series" focusing on the appropriate structure of wellness activities and everyday necessities that promote physician wellness; a two-module section on physician suicide and self-help; a four-module "Clinical Care Series" focusing on delivering bad news, navigating difficult patient encounters, dealing with difficult consultants and staff members, and debriefing traumatic events in the emergency department; wellness in the workplace; and dealing with medical errors and shame. The resident wellness curriculum, derived from an evidence-based approach and input of residents from the Wellness Think Tank and the RWCS event, provides a guiding framework for residency programs in emergency medicine and potentially other specialties to improve physician wellness and promote a culture of wellness.

THE INTESTINAL MICROBIOME OF INFANTS AND THE USE OF PROBIOTICS

PubMed Central

Indrio, Flavia; Neu, Josef

2011-01-01

Purpose of the review The increasing use of probiotics in neonates deserves scrutiny of the therapeutic as well as potentially harmful effects of these bacteria. In this review we describe the possible application of probiotics in the more common disease in the neonatal period. Recent finding Recent advances our capability to identify microbes and their function in the gastrointestinal tract offer exciting opportunities to discover the pathophysiology of enigmatic diseases such as necrotizing enterocolitis (NEC) and late onset sepsis (LOS) in the neonate. The relationship of the resident intestinal microbes to neural and muscular processes such as intestinal motility and neurodevelopment are also being evaluated. Summary We focus the possibility of the application of probiotics for disorders of motility in the infant, NEC and LOS Here we will summarize some of the recent advances in these areas as they relate to clinical practice and discuss areas where additional research is needed. PMID:21415831

The influence of the intestinal microbiome on vaccine responses.

PubMed

Zimmermann, Petra; Curtis, Nigel

2018-06-13

There is substantial variation between individuals in the immune response to vaccinations. The intestinal microbiome plays a crucial rule in the development and regulation of the immune system and therefore its composition might affect how individuals respond to vaccinations. In this review, we summarise studies that investigated the influence of the intestinal microbiome on humoral and cellular vaccine responses. To date, only four studies (three in infants and one in adults) have investigated the influence of the intestinal microbiome on vaccine responses. All found an association between the intestinal microbiome and vaccine responses. Despite the heterogeneity in study designs (including different vaccines, schedules, timing of collection of stool and blood samples, analysis methods and reporting of results on different taxonomic levels), findings across studies were consistent: a higher relative abundance of the phylum Actinobacteria (oral and parenteral vaccines) and Firmicutes (oral vaccines) was associated with both higher humoral and higher cellular vaccine responses, while a higher relative abundance of the phylum Proteobacteria (oral and parenteral vaccines) and Bacteroidetes (oral vaccines) was associated with lower responses. Further, well-designed, adequately powered studies using whole-genome sequencing (to include the influence of viruses, fungi and parasites) are needed to investigate in more detail the influence of the intestinal microbiome on vaccine responses. This will help identify strategies to improve vaccine efficacy and duration of protection, particularly in infancy when the intestinal microbiome is more amenable to external influences and plays an important role in the development of the immune system. Copyright © 2018 Elsevier Ltd. All rights reserved.

Can Medical School Performance Predict Residency Performance? Resident Selection and Predictors of Successful Performance in Obstetrics and Gynecology

PubMed Central

Stohl, Hindi E.; Hueppchen, Nancy A.; Bienstock, Jessica L.

2010-01-01

Background During the evaluation process, Residency Admissions Committees typically gather data on objective and subjective measures of a medical student's performance through the Electronic Residency Application Service, including medical school grades, standardized test scores, research achievements, nonacademic accomplishments, letters of recommendation, the dean's letter, and personal statements. Using these data to identify which medical students are likely to become successful residents in an academic residency program in obstetrics and gynecology is difficult and to date, not well studied. Objective To determine whether objective information in medical students' applications can help predict resident success. Method We performed a retrospective cohort study of all residents who matched into the Johns Hopkins University residency program in obstetrics and gynecology between 1994 and 2004 and entered the program through the National Resident Matching Program as a postgraduate year-1 resident. Residents were independently evaluated by faculty and ranked in 4 groups according to perceived level of success. Applications from residents in the highest and lowest group were abstracted. Groups were compared using the Fisher exact test and the Student t test. Results Seventy-five residents met inclusion criteria and 29 residents were ranked in the highest and lowest quartiles (15 in highest, 14 in lowest). Univariate analysis identified no variables as consistent predictors of resident success. Conclusion In a program designed to train academic obstetrician-gynecologists, objective data from medical students' applications did not correlate with successful resident performance in our obstetrics-gynecology residency program. We need to continue our search for evaluation criteria that can accurately and reliably select the medical students that are best fit for our specialty. PMID:21976076

Community composition, diversity, and metabolism of intestinal microbiota in cultivated European eel (Anguilla anguilla).

PubMed

Huang, Wei; Cheng, Zhiqiang; Lei, Shaonan; Liu, Lanying; Lv, Xin; Chen, Lihua; Wu, Miaohong; Wang, Chao; Tian, Baoyu; Song, Yongkang

2018-05-01

The intestinal tract, which harbours tremendous numbers of bacteria, plays a pivotal role in the digestion and absorption of nutrients. Here, high-throughput sequencing technology was used to determine the community composition and complexity of the intestinal microbiota in cultivated European eels during three stages of their lifecycle, after which the metabolic potentials of their intestinal microbial communities were assessed. The results demonstrated that European eel intestinal microbiota were dominated by bacteria in the phyla Proteobacteria and Fusobacteria. Statistical analyses revealed that the three cultured European eel life stages (elver, yellow eel, and silver eel) shared core microbiota dominated by Aeromonas. Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt) predictions of metagenome function revealed that the European eel intestinal microbiota might play significant roles in host nutrient metabolism. Biolog AN MicroPlate™ analysis and extracellular enzyme assays of culturable intestinal bacteria showed that the intestinal microbiota have a marked advantage in the metabolism of starch, which is the main carbohydrate component in European eel formulated feed. Understanding the ecology and functions of the intestinal microbiota during different developmental stages will help us improve the effects of fish-based bacteria on the composition and metabolic capacity of nutrients in European eels.

Pine Ridge Indian Health Service Primary Care Resident Rotation: an update.

PubMed

Vogt, H B; Jerde, O M

1994-04-01

The Pine Ridge Indian Health Service Primary Care Resident Rotation has been in existence for 2 years. It was conceived in an effort to help address the problem of recruitment and retention of physicians at Pine Ridge in the long term, while offering a unique educational experience for primary care residents. Twenty-five residents from family practice, general internal medicine, and general pediatric residency programs across the country have participated in calendar years 1992 and 1993. Three of the original 12 residents have returned following completion of their residency programs to join the Pine Ridge medical staff.

Interactions between bacteria and the gut mucosa: Do enteric neurotransmitters acting on the mucosal epithelium influence intestinal colonization or infection?

USDA-ARS?s Scientific Manuscript database

The intestinal epithelium is a critical barrier between the internal and external milieux of the mammalian host. Epithelial interactions between these two host environments have been shown to be modulated by several different, cross-communicating cell types residing in the gut mucosa. These includ...

Interactions between bacteria and the gut mucosa: Do enteric neurotransmitters acting on the mucosal epithelium influence intestinal colonization or infection?

USDA-ARS?s Scientific Manuscript database

The intestinal epithelium is a critical barrier between the internal and external milieux of the mammalian host. Epithelial interactions between these two host environments have been shown to be modulated by several different, cross-communicating cell types residing in the gut mucosa. These include ...

Maintaining intestinal health: the genetics and immunology of very early onset inflammatory bowel disease.

PubMed

Kelsen, Judith R; Baldassano, Robert N; Artis, David; Sonnenberg, Gregory F

2015-09-01

Inflammatory bowel disease (IBD) is a multifactoral disease caused by dysregulated immune responses to commensal or pathogenic microbes in the intestine, resulting in chronic intestinal inflammation. An emerging population of patients with IBD occurring before the age of 5 represent a unique form of disease, termed Very Early Onset (VEO)-IBD, which is phenotypically- and genetically-distinct from older-onset IBD. VEO-IBD is associated with increased disease severity, aggressive progression and poor responsiveness to most conventional therapies. Further investigation into the causes and pathogenesis of VEO-IBD will help improve treatment strategies, and may lead to a better understanding of the mechanisms that are essential to maintain intestinal health or provoke the development of targeted therapeutic strategies to limit intestinal disease. Here we discuss the phenotypic nature of VEO-IBD, the recent identification of novel gene variants associated with disease, and functional immunologic studies interrogating the contribution of specific genetic variants to the development of chronic intestinal inflammation.

Mex3a marks slow-proliferating multilineage progenitors of the intestinal epithelium

PubMed Central

Barriga, Francisco M.; Montagni, Elisa; Mana, Miyeko; Guillaumet-Adkins, Amy; Hernando-Momblona, Xavier; Sevillano, Marta; Rodriguez-Esteban, Gustavo; Mendez-Lago, Maria; Buczacki, Simon J. A.; Gut, Ivo; Gut, Marta; Winton, Douglas J.; Yilmaz, Omer; Stephan-Otto, Camille; Hein, Holger; Batlle, Eduard

2017-01-01

SUMMARY The intestinal epithelium is continuously regenerated by highly proliferative Lgr5+ intestinal stem cells (ISCs). The existence of a population of quiescent ISCs has been suggested yet its identity and features remain controversial. Here we describe that the expression of the RNA-binding protein Mex3a labels a subpopulation of Lgr5+ cells that divide less frequently and contribute to regenerate all intestinal lineages with slow kinetics. Single cell transcriptomic analysis revealed two classes of Lgr5-high cells, one of them defined by the Mex3a-expression program and by low levels of proliferation genes. Lineage tracing experiments show that large fraction of Mex3a+ cell population is continuously recalled into the rapidly dividing self-renewing ISC pool in homeostatic conditions. Chemotherapy and radiation target preferentially rapidly dividing Lgr5+ cells but spare the Mex3a-high/Lgr5+ population, which helps sustain the renewal of the intestinal epithelium during treatment. PMID:28285904

Improving the medical school-residency transition.

PubMed

Morgan, Helen; Skinner, Bethany; Marzano, David; Fitzgerald, James; Curran, Diana; Hammoud, Maya

2017-10-01

In response to calls to improve the continuum between undergraduate and graduate medical education, many medical schools are creating electives designed to prepare students for residency training. There is a need for data that link improvements from these residency preparation courses to residency itself. Data is needed that links improvements from these residency preparation courses to residency OBJECTIVE: To examine senior medical student performance on the Association of Professors of Gynecology and Obstetrics (APGO) Preparation for Residency Knowledge Assessment before and after an obstetrics and gynaecology residency preparation elective, and to determine whether the knowledge improvements persisted to the start of the residency. All 13 students enrolled in the course completed the APGO knowledge assessment on the first and last day of the elective. Three months later, the students were asked to re-take the assessment immediately prior to the start of their residency. There was improvement in mean scores from the pre-test score of 66.4 per cent to the post-test score of 77.4 per cent. At the time of the pre-test, three of the 13 students (23%) had passing scores (70% or greater), and at the time of the post-test, 11 of the 13 (85%) had passing scores. Nine of the 13 students (69%) completed the APGO knowledge assessment immediately prior to the start of their residency. Those nine students had a mean pre-residency score of 76.4 per cent. Eight of the nine students (89%) passed the pre-residency test. Our data support the value of residency preparation electives for improving knowledge, and suggest that senior medical school electives can help to bridge the continuum between undergraduate and graduate medical education. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

The initiation of mutual-help groups within residential treatment settings.

PubMed

Salem, D A; Gant, L; Campbell, R

1998-08-01

Mutual- and self-help groups for persons with severe mental illness have typically been most accessible to individuals who live independently. In an effort to make their organization more accessible to those who live in residential treatment facilities, Schizophrenics Anonymous (SA) ran introductory mutual-help meetings in four group homes. The results of a quantitative/qualitative case study of this effort are reported. The SA meetings were characterized as more and less successful based on the criteria of residents' attendance, participation, evaluation of the meetings, and interest in continued participation. The following characteristics distinguished between more and less successful meetings: staff support, referent power (i.e., identification with group leaders), and resident characteristics (e.g., gender, education, marital status, level of symptomatology). In spite of behavioral and self-reported evidence of interest and involvement in the meetings and the potential for continued involvement in the organization, no group home residents continued their participation in SA following the introductory meetings. This finding is interpreted from an institutional theory perspective that focuses on incompatibility between the ideologies underlying mutual help and the residential treatment system.

Comparison between Two Decades of Prevalence of Intestinal Parasitic Diseases and Risk Factors in a Brazilian Urban Centre

PubMed Central

Alves de Oliveira Serra, Maria Aparecida; Chaves, Cristina de Souza; Branco Coêlho, Zirlane Castelo; de Castro Rodrigues, Naya Lúcia; Martins Vale, Josias; Teixeira, Maria Jânia; de Oliveira, Francisco Josemar Alves; de Araújo, Márcio Flávio Moura; Coelho, Ivo Castelo Branco

2015-01-01

Objectives. This study's objective was to compare the prevalence of intestinal parasites and associated risk factors in children in urban communities, in the Brazilian Northeast, between two decades. Methods. This quantitative transversal study consisted of a comparative analysis of two different samples: the first viewing the years 1992–1996 and the other through a coproepidemiological data survey undertaken in 2010-2011. Results. It was evidenced that there was a reduction of intestinal parasites and that there were improvements in the socioenvironmental conditions between the two decades evaluated. It was observed that, in the period 1992–1996, playing out in the streets was associated with a higher risk for acquiring intestinal parasites. Over the 2010-2011 period, the characteristics of more than five residents per household, houses with dirt floors, children who live in homes without piped water, and children who play out in the streets were associated with a higher risk of intestinal parasitic infection. Conclusion. The study showed a reduction of intestinal parasitic diseases to 23.8% in 2010-2011 from 81.3% in 1992–1996 and improvement of the social-sanitary conditions of the population between the decades analyzed. PMID:26692338

Comparison between Two Decades of Prevalence of Intestinal Parasitic Diseases and Risk Factors in a Brazilian Urban Centre.

PubMed

Alves de Oliveira Serra, Maria Aparecida; Chaves, Cristina de Souza; Branco Coêlho, Zirlane Castelo; de Castro Rodrigues, Naya Lúcia; Martins Vale, Josias; Teixeira, Maria Jânia; de Oliveira, Francisco Josemar Alves; de Araújo, Márcio Flávio Moura; Coelho, Ivo Castelo Branco

2015-01-01

Objectives. This study's objective was to compare the prevalence of intestinal parasites and associated risk factors in children in urban communities, in the Brazilian Northeast, between two decades. Methods. This quantitative transversal study consisted of a comparative analysis of two different samples: the first viewing the years 1992-1996 and the other through a coproepidemiological data survey undertaken in 2010-2011. Results. It was evidenced that there was a reduction of intestinal parasites and that there were improvements in the socioenvironmental conditions between the two decades evaluated. It was observed that, in the period 1992-1996, playing out in the streets was associated with a higher risk for acquiring intestinal parasites. Over the 2010-2011 period, the characteristics of more than five residents per household, houses with dirt floors, children who live in homes without piped water, and children who play out in the streets were associated with a higher risk of intestinal parasitic infection. Conclusion. The study showed a reduction of intestinal parasitic diseases to 23.8% in 2010-2011 from 81.3% in 1992-1996 and improvement of the social-sanitary conditions of the population between the decades analyzed.

Regulation of Intestinal Epithelial Cells Properties and Functions by Amino Acids.

PubMed

Kong, Shanshan; Zhang, Yanhui H; Zhang, Weiqiang

2018-01-01

Intestinal epithelial cells (IECs) line the surface of intestinal epithelium, where they play important roles in the digestion of food, absorption of nutrients, and protection of the human body from microbial infections, and others. Dysfunction of IECs can cause diseases. The development, maintenance, and functions of IECs are strongly influenced by external nutrition, such as amino acids. Amino acids play important roles in regulating the properties and functions of IECs. In this article, we briefly reviewed the current understanding of the roles of amino acids in the regulation of IECs' properties and functions in physiological state, including in IECs homeostasis (differentiation, proliferation, and renewal), in intestinal epithelial barrier structure and functions, and in immune responses. We also summarized some important findings on the effects of amino acids supplementation (e.g., glutamine and arginine) in restoring IECs' and intestine functions in some diseased states. These findings will further our understanding of the important roles of amino acids in the homeostasis of IECs and could potentially help identify novel targets and reagents for the therapeutic interventions of diseases associated with dysfunctional IECs.

Providing rapid feedback to residents on their teaching skills: an educational strategy for contemporary trainees.

PubMed

Katz-Sidlow, Rachel J; Baer, Tamar G; Gershel, Jeffrey C

2016-03-20

The objective of this study was to assess the attitudes of contemporary residents toward receiving rapid feedback on their teaching skills from their medical student learners. Participants consisted of 20 residents in their second post-graduate training year. These residents facilitated 44 teaching sessions with medical students within our Resident-as-Teacher program. Structured, written feedback from students was returned to the resident within 3 days following each session. Residents completed a short survey about the utility of the feedback, whether they would make a change to future teaching sessions based on the feedback, and what specifically they might change. The survey utilized a 4-point scale ("Not helpful/likely=1" to "Very helpful/likely=4"), and allowed for one free-text response. Free-text responses were hand-coded and underwent qualitative analysis to identify themes. There were 182 student feedback encounters resulting from 44 teaching sessions. The survey response rate was 73% (32/44). Ninety-four percent of residents rated the rapid feedback as "very helpful," and 91% would "very likely" make a change to subsequent sessions based on student feedback. Residents' proposed changes included modifications to session content and/or their personal teaching style. Residents found that rapid feedback received from medical student learners was highly valuable to them in their roles as teachers. A rapid feedback strategy may facilitate an optimal educational environment for contemporary trainees.

Local Inflammatory Cues Regulate Differentiation and Persistence of CD8+ Tissue-Resident Memory T Cells.

PubMed

Bergsbaken, Tessa; Bevan, Michael J; Fink, Pamela J

2017-04-04

Many pathogens initiate infection at mucosal surfaces, and tissue-resident memory T (Trm) cells play an important role in protective immunity, yet the tissue-specific signals that regulate Trm differentiation are poorly defined. During Yersinia infection, CD8 + T cell recruitment to areas of inflammation within the intestine is required for differentiation of the CD103 - CD69 + Trm subset. Intestinal proinflammatory microenvironments have elevated interferon (IFN)-β and interleukin-12 (IL-12), which regulated Trm markers, including CD103. Type I interferon-receptor- or IL-12-receptor-deficient T cells functioned similarly to wild-type (WT) cells during infection; however, the inability of T cells to respond to inflammation resulted in defective differentiation of CD103 - CD69 + Trm cells and reduced Trm persistence. Intestinal macrophages were the main producers of IFN-β and IL-12 during infection, and deletion of CCR2 + IL-12-producing cells reduced the size of the CD103 - Trm population. These data indicate that intestinal inflammation drives phenotypic diversity and abundance of Trm cells for optimal tissue-specific immunity. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

Primary peri-anal adenocarcinoma of intestinal type - a new proposed entity.

PubMed

Gill, Pelvender S; Wong, Newton A C S

2018-02-21

The currently recognised subtypes of anal canal/peri-anal adenocarcinoma are those arising from low rectal mucosa or columnar cuff, fistula-related tumours and anal gland carcinoma. This report presents two examples of a hitherto undescribed subtype of peri-anal adenocarcinoma with an intestinal phenotype. A 74-year-old man had a peri-anal tumour locally excised, whereas a 73-year-old female underwent an abdominoperineal resection for peri-anal Paget's disease with an underlying carcinoma. Neither patient had a history of perineal fistulae, Crohn's disease or previous gastrointestinal neoplasia, and neither showed clinical, radiological or endoscopic evidence of another abdominal or pelvic tumour. Both resection specimens contained adenocarcinoma, which were similar in demonstrating an intestinal morphology and CDX2 immunopositivity. The man has shown a disease-free outcome thus far, but the woman has suffered with nodal and pelvic recurrence within a few months of surgery. The name 'primary peri-anal adenocarcinoma of intestinal type' is proposed for this previously unrecognised subtype of perineal neoplasia. Awareness of its distinct existence - by recognising its intestinal morphology and immunophenotype while excluding metastasis from the intestinal tract - should help to collate data to determine its specific prognosis and to formulate its best management. © 2018 John Wiley & Sons Ltd.

Teaching physics to radiology residents.

PubMed

Hendee, William R

2009-04-01

The complexity of diagnostic imaging has expanded dramatically over the past two decades. Over the same period, the time and effort devoted to teaching physics (the science and technology of the discipline) have diminished. This paradox compromises the ability of future radiologists to master imaging technologies so that they are used in an efficient, safe, and cost-effective manner. This article addresses these issues. Efforts involving many professional organizations are under way to resolve the paradox of the expanding complexity of medical imaging contrasted with the declining emphasis on physics in radiology residency programs. These efforts should help to reestablish physics education as a core value in radiology residency programs.

Inflammation-associated alterations to the intestinal microbiota reduce colonization resistance against non-typhoidal Salmonella during concurrent malaria parasite infection.

PubMed

Mooney, Jason P; Lokken, Kristen L; Byndloss, Mariana X; George, Michael D; Velazquez, Eric M; Faber, Franziska; Butler, Brian P; Walker, Gregory T; Ali, Mohamed M; Potts, Rashaun; Tiffany, Caitlin; Ahmer, Brian M M; Luckhart, Shirley; Tsolis, Renée M

2015-10-05

Childhood malaria is a risk factor for disseminated infections with non-typhoidal Salmonella (NTS) in sub-Saharan Africa. While hemolytic anemia and an altered cytokine environment have been implicated in increased susceptibility to NTS, it is not known whether malaria affects resistance to intestinal colonization with NTS. To address this question, we utilized a murine model of co-infection. Infection of mice with Plasmodium yoelii elicited infiltration of inflammatory macrophages and T cells into the intestinal mucosa and increased expression of inflammatory cytokines. These mucosal responses were also observed in germ-free mice, showing that they are independent of the resident microbiota. Remarkably, P. yoelii infection reduced colonization resistance of mice against S. enterica serotype Typhimurium. Further, 16S rRNA sequence analysis of the intestinal microbiota revealed marked changes in the community structure. Shifts in the microbiota increased susceptibility to intestinal colonization by S. Typhimurium, as demonstrated by microbiota reconstitution of germ-free mice. These results show that P. yoelii infection, via alterations to the microbial community in the intestine, decreases resistance to intestinal colonization with NTS. Further they raise the possibility that decreased colonization resistance may synergize with effects of malaria on systemic immunity to increase susceptibility to disseminated NTS infections.

Inflammation-associated alterations to the intestinal microbiota reduce colonization resistance against non-typhoidal Salmonella during concurrent malaria parasite infection

PubMed Central

Mooney, Jason P.; Lokken, Kristen L.; Byndloss, Mariana X.; George, Michael D.; Velazquez, Eric M.; Faber, Franziska; Butler, Brian P.; Walker, Gregory T.; Ali, Mohamed M.; Potts, Rashaun; Tiffany, Caitlin; Ahmer, Brian M. M.; Luckhart, Shirley; Tsolis, Renée M.

2015-01-01

Childhood malaria is a risk factor for disseminated infections with non-typhoidal Salmonella (NTS) in sub-Saharan Africa. While hemolytic anemia and an altered cytokine environment have been implicated in increased susceptibility to NTS, it is not known whether malaria affects resistance to intestinal colonization with NTS. To address this question, we utilized a murine model of co-infection. Infection of mice with Plasmodium yoelii elicited infiltration of inflammatory macrophages and T cells into the intestinal mucosa and increased expression of inflammatory cytokines. These mucosal responses were also observed in germ-free mice, showing that they are independent of the resident microbiota. Remarkably, P. yoelii infection reduced colonization resistance of mice against S. enterica serotype Typhimurium. Further, 16S rRNA sequence analysis of the intestinal microbiota revealed marked changes in the community structure. Shifts in the microbiota increased susceptibility to intestinal colonization by S. Typhimurium, as demonstrated by microbiota reconstitution of germ-free mice. These results show that P. yoelii infection, via alterations to the microbial community in the intestine, decreases resistance to intestinal colonization with NTS. Further they raise the possibility that decreased colonization resistance may synergize with effects of malaria on systemic immunity to increase susceptibility to disseminated NTS infections. PMID:26434367

Resident Health Advocates in Public Housing Family Developments

PubMed Central

Bowen, Deborah J; Bhosrekar, Sarah Gees; Rorie, Jo-Anna; Goodman, Rachel; Thomas, Gerry; Maxwell, Nancy Irwin; Smith, Eugenia

2015-01-01

Translation of research to practice often needs intermediaries to help the process occur. Our Prevention Research Center has identified a total of 89 residents of public housing in the last 11 years who have been working in the Resident Health Advocate (RHA) program to engage residents in improving their own and other residents’ health status, by becoming trained in skills needed by Community Health Workers. Future directions include training for teens to become Teen RHAs and further integration of our RHA program with changes in the health care system and in the roles of community health workers in general. PMID:25739061

Anonymity and Electronics: Adapting Preparation for Radiology Resident Examination.

PubMed

Chapman, Teresa; Reid, Janet R; O'Conner, Erin E

2017-06-01

Diagnostic radiology resident assessment has evolved from a traditional oral examination to computerized testing. Teaching faculty struggle to reconcile the differences between traditional teaching methods and residents' new preferences for computerized testing models generated by new examination styles. We aim to summarize the collective experiences of senior residents at three different teaching hospitals who participated in case review sessions using a computer-based, interactive, anonymous teaching tool, rather than the Socratic method. Feedback was collected from radiology residents following participation in a senior resident case review session using Nearpod, which allows residents to anonymously respond to the teaching material. Subjective resident feedback was uniformly enthusiastic. Ninety percent of residents favor a case-based board review incorporating multiple-choice questions, and 94% favor an anonymous response system. Nearpod allows for inclusion of multiple-choice questions while also providing direct feedback to the teaching faculty, helping to direct the instruction and clarify residents' gaps in knowledge before the Core Examination. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Stress responsive miR-31 is a major modulator of mouse intestinal stem cells during regeneration and tumorigenesis.

PubMed

Tian, Yuhua; Ma, Xianghui; Lv, Cong; Sheng, Xiaole; Li, Xiang; Zhao, Ran; Song, Yongli; Andl, Thomas; Plikus, Maksim V; Sun, Jinyue; Ren, Fazheng; Shuai, Jianwei; Lengner, Christopher J; Cui, Wei; Yu, Zhengquan

2017-09-05

Intestinal regeneration and tumorigenesis are believed to be driven by intestinal stem cells (ISCs). Elucidating mechanisms underlying ISC activation during regeneration and tumorigenesis can help uncover the underlying principles of intestinal homeostasis and disease including colorectal cancer. Here we show that miR-31 drives ISC proliferation, and protects ISCs against apoptosis, both during homeostasis and regeneration in response to ionizing radiation injury. Furthermore, miR-31 has oncogenic properties, promoting intestinal tumorigenesis. Mechanistically, miR-31 acts to balance input from Wnt, BMP, TGFβ signals to coordinate control of intestinal homeostasis, regeneration and tumorigenesis. We further find that miR-31 is regulated by the STAT3 signaling pathway in response to radiation injury. These findings identify miR-31 as a critical modulator of ISC biology, and a potential therapeutic target for a broad range of intestinal regenerative disorders and cancers.

Modification of composition and spatial distribution of intestinal microbiota following antibiotic therapy in immunocompetent defined flora C3H/HeN mice

USDA-ARS?s Scientific Manuscript database

Background: Luminal bacteria and/or their products play a pivotal role in the pathogenesis of chronic intestinal inflammation associated with inflammatory bowel diseases (IBD). While host responses to resident flora may initiate IBD, the subsets of bacteria responsible for mediating inflammation in ...

Informatics and Technology in Resident Education.

PubMed

Niehaus, William

2017-05-01

Biomedical or clinical informatics is the transdisciplinary field that studies and develops effective uses of biomedical data, information technology innovations, and medical knowledge for scientific inquiry, problem solving, and decision making, with an emphasis on improving human health. Given the ongoing advances in information technology, the field of informatics is becoming important to clinical practice and to residency education. This article will discuss how informatics is specifically relevant to residency education and the different ways to incorporate informatics into residency education, and will highlight applications of current technology in the context of residency education. How informatics can optimize communication for residents, promote information technology use, refine documentation techniques, reduce medical errors, and improve clinical decision making will be reviewed. It is hoped that this article will increase faculty and trainees' knowledge of the field of informatics, awareness of available technology, and will assist practitioners to maximize their ability to provide quality care to their patients. This article will also introduce the idea of incorporating informatics specialists into residency programs to help practitioners deliver more evidenced-based care and to further improve their efficiency. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Is Canadian surgical residency training stressful?

PubMed

Aminazadeh, Nasser; Farrokhyar, Forough; Naeeni, Amir; Naeeni, Marjan; Reid, Susan; Kashfi, Arash; Kahnamoui, Kamyar

2012-08-01

Surgical residency has the reputation of being arduous and stressful. We sought to determine the stress levels of surgical residents, the major causes of stress and the coping mechanisms used. We developed and distributed a survey among surgical residents across Canada. A total of 169 participants responded: 97 (57%) male and 72 (43%) female graduates of Canadian (83%) or foreign (17%) medical schools. In all, 87% reported most of the past year of residency as somewhat stressful to extremely stressful, with time pressure (90%) being the most important stressor, followed by number of working hours (83%), residency program (73%), working conditions (70%), caring for patients (63%) and financial situation (55%). Insufficient sleep and frequent call was the component of residency programs that was most commonly rated as highly stressful (31%). Common coping mechanisms included staying optimistic (86%), engaging in enjoyable activities (83%), consulting others (75%) and exercising (69%). Mental or emotional problems during residency were reported more often by women (p = 0.006), who were also more likely than men to seek help (p = 0.026), but men reported greater financial stress (p = 0.036). Foreign graduates reported greater stress related to working conditions (p < 0.001), residency program (p = 0.002), caring for family members (p = 0.006), discrimination (p < 0.001) and personal and family safety (p < 0.001) than Canadian graduates. Time pressure and working hours were the most common stressors overall, and lack of sleep and call frequency were the most stressful components of the residency program. Female sex and graduating from a non-Canadian medical school increased the likelihood of reporting stress in certain areas of residency.

Impact of Intervention to Improve Nursing Home Resident-Staff Interactions and Engagement.

PubMed

Hartmann, Christine W; Mills, Whitney L; Pimentel, Camilla B; Palmer, Jennifer A; Allen, Rebecca S; Zhao, Shibei; Wewiorski, Nancy J; Sullivan, Jennifer L; Dillon, Kristen; Clark, Valerie; Berlowitz, Dan R; Snow, Andrea Lynn

2018-04-30

For nursing home residents, positive interactions with staff and engagement in daily life contribute meaningfully to quality of life. We sought to improve these aspects of person-centered care in an opportunistic snowball sample of six Veterans Health Administration nursing homes (e.g., Community Living Centers-CLCs) using an intervention that targeted staff behavior change, focusing on improving interactions between residents and staff and thereby ultimately aiming to improve resident engagement. We grounded this mixed-methods study in the Capability, Opportunity, Motivation, Behavior (COM-B) model of behavior change. We implemented the intervention by (a) using a set of evidence-based practices for implementing quality improvement and (b) combining primarily CLC-based staff facilitation with some researcher-led facilitation. Validated resident and staff surveys and structured observations collected pre and post intervention, as well as semi-structured staff interviews conducted post intervention, helped assess intervention success. Sixty-two CLC residents and 308 staff members responded to the surveys. Researchers conducted 1,490 discrete observations. Intervention implementation was associated with increased staff communication with residents during the provision of direct care and decreased negative staff interactions with residents. In the 66 interviews, staff consistently credited the intervention with helping them (a) develop awareness of the importance of identifying opportunities for engagement and (b) act to improve the quality of interactions between residents and staff. The intervention proved feasible and influenced staff to make simple enhancements to their behaviors that improved resident-staff interactions and staff-assessed resident engagement.

Annual State of Connecticut Obstetrics and Gynecology Resident Research Day.

PubMed

Seagle, Brandon-Luke L; Ballard, Jennifer; Kakar, Freshta; Panarelli, Erin; Samuelson, Robert; Shahabi, Shohreh

2015-01-01

To increase opportunities for Obstetrics and Gynecology(Ob/Gyn) residents to present their research, an Annual State of Connecticut Ob/Gyn Resident Research Day (RRD) was created. At the first annual RRD, 33 residents, representing five of six Connecticut Ob/Gyn residency programs, presented 39 poster and eight oral presentations. RRD evaluators rated the overall symposium and the quality of resident oral and poster presentations as either "excellent" or "above average." Residency program directors reported that the symposium was "very helpful" for evidencing resident scholarship as required by the Accreditation Council for Graduate Medical Education (ACGME). Surveyed residents reported that the symposium promoted their research and was a valuable investment of their time. An annual specialty-specific, statewide RRD was created, experienced good participation, and was well evaluated. The annual, statewide Ob/Gyn RRD may serve as a model for development of other specialty-specific, statewide RRD events.

Residents' leadership styles and effectiveness as perceived by nurses.

PubMed

McCue, J D; Magrinat, G; Hansen, C J; Bailey, R S

1986-01-01

Although physicians are required to act as leaders in a variety of situations, leadership ability and leadership training have been largely ignored by medical educators. The leadership styles and leadership effectiveness of 17 residents in a community hospital were studied as part of a leadership training seminar. Self-ratings and ratings of the residents by nurses who had worked with them were used to assess the residents' leadership style and the nurses' perceptions of the effectiveness of those styles. Styles that emphasized relationships with co-workers (encouraging and coaching styles) predominated over low relationship-oriented styles (delegating and structuring). The nurses perceived individual residents who exhibited encouraging and coaching leadership styles as being distinctly more effective leaders than the residents who exhibited structuring and delegating styles. The residents, however, rated all four styles as similarly effective. Leadership training programs and studies of the type reported here may provide an opportunity for faculty members to help residents learn more appropriate and productive styles of leadership.

Constructing the meaning of quality of life for residents in care homes in the Lebanon: perspectives of residents, staff and family.

PubMed

Adra, Marina Gharibian; Hopton, John; Keady, John

2015-12-01

Located in two care homes in Lebanon, the study explores the perspectives of quality of life for a sample of older residents, care staff and family caregivers. Quality of life for older people living in care homes is traditionally reported in the literature as a Westernised construct and so far little is known about its meanings from an Arabic cultural perspective and context. There is also a knowledge gap about the conditions of older people living in care homes in Lebanon. The study was a qualitative exploration of perspectives of quality of life of older residents, care staff and family caregivers. Two care homes for older people situated in Beirut took part in the study. Between 2010 and 2011 semi-structured interviews were undertaken with a sample of 20 residents, eight family caregivers and 11 care staff. Data were analysed using the constant comparative method. Four categories emerged from this analytical process: (i) maintaining family connectedness; (ii) engaging in worthwhile activities; (iii) maintaining and developing significant relationships; and (iv) holding and practicing spiritual beliefs. The emergence of these categories confirmed the complex, interrelated and multidimensional nature of quality of life for residents and other stakeholders. The findings supplement an emerging body of knowledge about the composition of quality of life for older residents in Lebanon. Improving the quality of life of older residents will require action in respect of all of the domains identified in study. Moving nursing practice from task-based care to relationship-centred approaches was seen as pivotal in helping to develop quality of life for residents living in the participating care homes. The findings have implications for education, nursing practice and research in Lebanon and help start an evidence base for care. © 2015 John Wiley & Sons Ltd.

New approaches to increase intestinal length: Methods used for intestinal regeneration and bioengineering

PubMed Central

Shirafkan, Ali; Montalbano, Mauro; McGuire, Joshua; Rastellini, Cristiana; Cicalese, Luca

2016-01-01

Inadequate absorptive surface area poses a great challenge to the patients suffering a variety of intestinal diseases causing short bowel syndrome. To date, these patients are managed with total parenteral nutrition or intestinal transplantation. However, these carry significant morbidity and mortality. Currently, by emergence of tissue engineering, anticipations to utilize an alternative method to increase the intestinal absorptive surface area are increasing. In this paper, we will review the improvements made over time in attempting elongating the intestine with surgical techniques as well as using intestinal bioengineering. Performing sequential intestinal lengthening was the preliminary method applied in humans. However, these methods did not reach widespread use and has limited outcome. Subsequent experimental methods were developed utilizing scaffolds to regenerate intestinal tissue and organoids unit from the intestinal epithelium. Stem cells also have been studied and applied in all types of tissue engineering. Biomaterials were utilized as a structural support for naive cells to produce bio-engineered tissue that can achieve a near-normal anatomical structure. A promising novel approach is the elongation of the intestine with an acellular biologic scaffold to generate a neo-formed intestinal tissue that showed, for the first time, evidence of absorption in vivo. In the large intestine, studies are more focused on regeneration and engineering of sphincters and will be briefly reviewed. From the review of the existing literature, it can be concluded that significant progress has been achieved in these experimental methods but that these now need to be fully translated into a pre-clinical and clinical experimentation to become a future viable therapeutic option. PMID:27011901

Intestinal Leiomyositis: A Cause of Chronic Intestinal Pseudo-Obstruction in 6 Dogs.

PubMed

Zacuto, A C; Pesavento, P A; Hill, S; McAlister, A; Rosenthal, K; Cherbinsky, O; Marks, S L

2016-01-01

Intestinal leiomyositis is a suspected autoimmune disorder affecting the muscularis propria layer of the gastrointestinal tract and is a cause of chronic intestinal pseudo-obstruction in humans and animals. To characterize the clinical presentation, histopathologic features, and outcome of dogs with intestinal leiomyositis in an effort to optimize treatment and prognosis. Six client-owned dogs. Retrospective case series. Medical records were reviewed to describe signalment, clinicopathologic and imaging findings, histopathologic diagnoses, treatment, and outcome. All biopsy specimens were reviewed by a board-certified pathologist. Median age of dogs was 5.4 years (range, 15 months-9 years). Consistent clinical signs included vomiting (6/6), regurgitation (2/6), and small bowel diarrhea (3/6). Median duration of clinical signs before presentation was 13 days (range, 5-150 days). Diagnostic imaging showed marked gastric distension with dilated small intestines in 4/6 dogs. Full-thickness intestinal biopsies were obtained in all dogs by laparotomy. Histopathology of the stomach and intestines disclosed mononuclear inflammation, myofiber degeneration and necrosis, and fibrosis centered within the region of myofiber loss in the intestinal muscularis propria. All dogs received various combinations of immunomodulatory and prokinetic treatment, antimicrobial agents, antiemetics, and IV fluids, but none of the dogs showed a clinically relevant improvement with treatment. Median survival was 19 days after diagnosis (range, 3-270 days). Intestinal leiomyositis is a cause of intestinal pseudo-obstruction and must be diagnosed by full-thickness intestinal biopsy. This disease should be considered in dogs with acute and chronic vomiting, regurgitation, and small bowel diarrhea. Copyright © 2015 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

The intestinal complement system in inflammatory bowel disease: Shaping intestinal barrier function.

PubMed

Sina, Christian; Kemper, Claudia; Derer, Stefanie

2018-06-01

The complement system is part of innate sensor and effector systems such as the Toll-like receptors (TLRs). It recognizes and quickly systemically and/or locally respond to microbial-associated molecular patterns (MAMPs) with a tailored defense reaction. MAMP recognition by intestinal epithelial cells (IECs) and appropriate immune responses are of major importance for the maintenance of intestinal barrier function. Enterocytes highly express various complement components that are suggested to be pivotal for proper IEC function. Appropriate activation of the intestinal complement system seems to play an important role in the resolution of chronic intestinal inflammation, while over-activation and/or dysregulation may worsen intestinal inflammation. Mice deficient for single complement components suffer from enhanced intestinal inflammation mimicking the phenotype of patients with chronic inflammatory bowel disease (IBD) such as Crohn's disease (CD) or ulcerative colitis (UC). However, the mechanisms leading to complement expression in IECs seem to differ markedly between UC and CD patients. Hence, how IECs, intestinal bacteria and epithelial cell expressed complement components interact in the course of IBD still remains to be mostly elucidated to define potential unique patterns contributing to the distinct subtypes of intestinal inflammation observed in CD and UC. Copyright © 2018 Elsevier Ltd. All rights reserved.

Operative Landscape at Canadian Neurosurgery Residency Programs.

PubMed

Tso, Michael K; Dakson, Ayoub; Ahmed, Syed Uzair; Bigder, Mark; Elliott, Cameron; Guha, Daipayan; Iorio-Morin, Christian; Kameda-Smith, Michelle; Lavergne, Pascal; Makarenko, Serge; Taccone, Michael S; Wang, Bill; Winkler-Schwartz, Alexander; Sankar, Tejas; Christie, Sean D

2017-07-01

Background Currently, the literature lacks reliable data regarding operative case volumes at Canadian neurosurgery residency programs. Our objective was to provide a snapshot of the operative landscape in Canadian neurosurgical training using the trainee-led Canadian Neurosurgery Research Collaborative. Anonymized administrative operative data were gathered from each neurosurgery residency program from January 1, 2014, to December 31, 2014. Procedures were broadly classified into cranial, spine, peripheral nerve, and miscellaneous procedures. A number of prespecified subspecialty procedures were recorded. We defined the resident case index as the ratio of the total number of operations to the total number of neurosurgery residents in that program. Resident number included both Canadian medical and international medical graduates, and included residents on the neurosurgery service, off-service, or on leave for research or other personal reasons. Overall, there was an average of 1845 operative cases per neurosurgery residency program. The mean numbers of cranial, spine, peripheral nerve, and miscellaneous procedures were 725, 466, 48, and 193, respectively. The nationwide mean resident case indices for cranial, spine, peripheral nerve, and total procedures were 90, 58, 5, and 196, respectively. There was some variation in the resident case indices for specific subspecialty procedures, with some training programs not performing carotid endarterectomy or endoscopic transsphenoidal procedures. This study presents the breadth of neurosurgical training within Canadian neurosurgery residency programs. These results may help inform the implementation of neurosurgery training as the Royal College of Physicians and Surgeons residency training transitions to a competence-by-design curriculum.

Help me, help me.

PubMed

Simard, Joyce

2017-10-01

Disruptive vocalization and resisting personal care is a problem for staff in most skilled nursing facilities. Often these behaviors result in the resident being treated with antipsychotics. The Namaste Care program which takes place in a calm environment and offers a loving touch approach to care, has been successful in eliminating these behaviors. The room or space where Namaste Care takes place is as free from disruption as possible and as the resident is welcomed into the room, the calming music and scent of lavender surrounds them. In this case report, the resident stopped crying out as soon as she entered the room. This resident also became comfortable with being touched when touch was offered in a slow, loving manner. Much to the delight of staff this had a "trickle down" effect as the resident stopped resisting care even when she was out of the Namaste Care room. The result was that this resident's last year of life was filled with loving care until she took her last breath.

What Residence Hall Staff Need to Know about Dealing with Death.

ERIC Educational Resources Information Center

Jacobs, Bonita; Towns, James E.

1984-01-01

Emphasizes the responsibility for residence hall staff to understand the grief process. An adaptation of Kubler-Ross's stages of death has produced helpful techniques for successfully accepting the death. Through understanding these principles, staff can become aware of the grief process and can assist residents. (JAC)

The Short isoform of the CEACAM1 receptor in intestinal T cells regulates mucosal immunity and homeostasis via Tfh cell induction

PubMed Central

Chen, Lanfen; Chen, Zhangguo; Baker, Kristi; Halvorsen, E lizabeth M.; da Cunha, Andre Pires; Flak, Magdalena B.; Gerber, Georg; Huang, Yu-Hwa; Hosomi, Shuhei; Arthur, J anelle C.; Dery, Ken J.; Nagaishi, Takashi; Beauchemin, Nicole; Holmes, Kathryn V.; Ho, Joshua W. K.; Shively, John E.; Jobin, Christian; Onderdonk, Andrew B.; Bry, Lynn; Weiner, Howard L.; Higgins, Darren E.; Blumberg, Richard S.

2012-01-01

Summary Carcinoembryonic antigen cell adhesion molecule like I (CEACAM1) is expressed on activated T cells and signals through either a long (L) cytoplasmic tail containing immune receptor tyrosine based inhibitory motifs, which provide inhibitory function, or a short (S) cytoplasmic tail with an unknown role. Previous studies on peripheral T cells show that CEACAM1-L isoforms predominate with little to no detectable CEACAM1-S isoforms in mouse and human. We show here that this was not the case in tissue resident T cells of intestines and gut associated lymphoid tissues which demonstrated predominant expression of CEACAM1-S isoforms relative to CEACAM1-L isoforms in human and mouse. This tissue resident predominance of CEACAM1-S expression was determined by the intestinal environment where it served a stimulatory function leading to the regulation of T cell subsets associated with generation of secretory IgA immunity, the regulation of mucosal commensalism, and defense of the barrier against enteropathogens. PMID:23123061

Ambiguities: residents' experience of 'nursing home as my home'.

PubMed

Nakrem, Sigrid; Vinsnes, Anne G; Harkless, Gene E; Paulsen, Bård; Seim, Arnfinn

2013-09-01

Residential care in nursing homes continues to be necessary for those individuals who are no longer able to live at home. Uncovering what nursing home residents' view as quality of care in nursing homes will help further understanding of how best to provide high quality, person-centred care. To describe residents' experiences of living in a nursing home related to quality of care. The study utilises a descriptive exploratory design. In-depth interviews were undertaken with 15 residents who were not cognitively impaired, aged 65 and over and living in one of four nursing homes. The interviews were transcribed verbatim and analysed by categorising of meaning. Residents perceived the nursing home as their home, but at the same time not 'a home'. This essential ambiguity created the tension from which the categories of perceptions of quality emerged. Four main categories of quality of care experience were identified: 'Being at home in a nursing home', 'Paying the price for 24-hour care', 'Personal habits and institutional routines', and 'Meaningful activities for a meaningful day'. Ambiguities concerning the nursing home as a home and place to live, a social environment in which the residents experience most of their social life and the institution where professional health service is provided were uncovered. High-quality care was when ambiguities were managed well and a home could be created within the institution. Implication for practice. Achieving quality care in nursing homes requires reconciling the ambiguities of the nursing home as a home. This implies helping residents to create a private home distinct from the professional home, allowing residents' personal habits to guide institutional routines and supporting meaningful activities. Using these resident developed quality indicators is an important step in improving nursing home services. © 2012 Blackwell Publishing Ltd.

Disorders of the Small Intestine

MedlinePlus

... Esophagus Disorders of the Stomach Disorders of the Small Intestine Disorders of the Large Intestine Disorders of ... Esophagus Disorders of the Stomach Disorders of the Small Intestine Disorders of the Large Intestine Disorders of ...

EICOSAPENTAENOIC ACID ENHANCES HEATSTROKE-IMPAIRED INTESTINAL EPITHELIAL BARRIER FUNCTION IN RATS.

PubMed

Xiao, Guizhen; Yuan, Fangfang; Geng, Yan; Qiu, Xiaowen; Liu, Zhifeng; Lu, Jiefu; Tang, Liqun; Zhang, Yali; Su, Lei

2015-10-01

Dysfunction of the intestinal barrier plays an important role in the pathological process of heatstroke. Omega-3 (or n-3) polyunsaturated fatty acids, including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), help protect the intestinal mucosal barrier. This study assessed if pretreating rats with EPA or DHA could alleviate heat stress-induced damage to the intestinal barrier caused by experimental heatstroke. Male Wistar rats were pregavaged with either EPA, DHA, corn oil, or normal saline (all 1 g/kg) for 21 days before the heatstroke experiment (control rats were not exposed to heat). Experimental rats were exposed to an ambient temperature of 37°C and 60% humidity to induce heatstroke, and then they were allowed to recover at room temperature after rapid cooling. Survival time of rats was monitored after heatstroke. Horseradish peroxidase flux from the gut lumen and the level of plasma D-lactate were measured to analyze intestinal permeability at 6 h after heatstroke. Plasma endotoxin levels were determined using a limulus amoebocyte lysate assay. Expressions of the tight junction (TJ) proteins occludin and ZO-1 were analyzed by Western blot and localized by immunofluorescence microscopy. Tight junction protein morphology was observed by transmission electron microscopy. Fatty acids of ileal mucosa were analyzed using gas chromatography-mass selective detector. Eicosapentaenoic acid significantly increased survival time after heatstroke. Eicosapentaenoic acid significantly decreased intestinal permeability and plasma endotoxin levels. Eicosapentaenoic acid effectively attenuated the heatstroke-induced disruption of the intestinal structure and improved the histology score, whereas DHA was less effective, and corn oil was ineffective. Pretreatment with EPA also increased expression of occludin and ZO-1 to effectively prevent TJ disruption. Eicosapentaenoic acid pretreatment enriched itself in the membrane of intestinal cells. Our results

[Congenital intestinal lymphangiectasia].

PubMed

Popović, Dugan D j; Spuran, Milan; Alempijević, Tamara; Krstić, Miodrag; Djuranović, Srdjan; Kovacević, Nada; Damnjanović, Svetozar; Micev, Marjan

2011-03-01

Congenital intestinal lymphangiectasia is a disease which leads to protein losing enteropathy. Tortuous, dilated lymphatic vessels in the intestinal wall and mesenterium are typical features of the disease. Clinical manifestations include malabsorption, diarrhea, steatorrhea, edema and effusions. Specific diet and medication are required for disease control. A 19-year old male patient was hospitalized due to diarrhea, abdominal swelling, weariness and fatigue. Physical examination revealed growth impairment, ascites, and lymphedema of the right hand and forearm. Laboratory assessment indicated iron deficiency anaemia, lymphopenia, malabsorption, inflammatory syndrome, and urinary infection. Enteroscopy and video capsule endoscopy demonstrated dilated lymphatic vessels in the small intestine. The diagnosis was confirmed by intestinal biopsy. The patient was put on high-protein diet containing medium-chain fatty acids, somatotropin and supportive therapy. Congenital intestinal lymphangiectasia is a rare disease, usually diagnosed in childhood. Early recognition of the disease and adequate treatment can prevent development of various complications.

Altering workplace attitudes for resident education (A.W.A.R.E.): discovering solutions for medical resident bullying through literature review.

PubMed

Leisy, Heather B; Ahmad, Meleha

2016-04-27

Physicians-in-training are challenged every day with grueling academic requirements, job strain, and patient safety concerns. Residency shapes the skills and values that will percolate to patient care and professional character. Unfortunately, impediments to the educational process due to medical resident mistreatment by bullying remain highly prevalent in training today. A PubMed literature review was undertaken using key terms to help define resident mistreatment by bullying, determine its prevalence, identify its potential causes and sequelae, and find suggestions for changing this detrimental culture of medical training. We identified 62 relevant articles. The most frequently noted form of mistreatment was verbal abuse, with the most common perpetrators being fellow physicians of higher hierarchical power. Mistreatment exists due to its cyclical nature and the existing culture of medical training. These disruptive behaviors affect the wellbeing of both medical residents and patients. This article highlights the importance of creating systems that educate physicians-in-training about professional mistreatment by bullying and the imperative in recognizing and correcting these abuses. Resident bullying leads to increased resident stress, decreased resident wellbeing as well as risks to patient safety and increased healthcare costs. Solutions include education of healthcare team members, committee creation, regulation of feedback, and creation of a zero-tolerance policy focused on the health of both patients and residents. Altering workplace attitudes will diminish the detrimental effects that bullying has on resident training.

Resident Self-Assessment and Learning Goal Development: Evaluation of Resident-Reported Competence and Future Goals.

PubMed

Li, Su-Ting T; Paterniti, Debora A; Tancredi, Daniel J; Burke, Ann E; Trimm, R Franklin; Guillot, Ann; Guralnick, Susan; Mahan, John D

2015-01-01

To determine incidence of learning goals by competency area and to assess which goals fall into competency areas with lower self-assessment scores. Cross-sectional analysis of existing deidentified American Academy of Pediatrics' PediaLink individualized learning plan data for the academic year 2009-2010. Residents self-assessed competencies in the 6 Accreditation Council for Graduate Medical Education (ACGME) competency areas and wrote learning goals. Textual responses for goals were mapped to 6 ACGME competency areas, future practice, or personal attributes. Adjusted mean differences and associations were estimated using multiple linear and logistic regression. A total of 2254 residents reported 6078 goals. Residents self-assessed their systems-based practice (51.8) and medical knowledge (53.0) competencies lowest and professionalism (68.9) and interpersonal and communication skills (62.2) highest. Residents were most likely to identify goals involving medical knowledge (70.5%) and patient care (50.5%) and least likely to write goals on systems-based practice (11.0%) and professionalism (6.9%). In logistic regression analysis adjusting for postgraduate year (PGY), gender, and degree type (MD/DO), resident-reported goal area showed no association with the learner's relative self-assessment score for that competency area. In the conditional logistic regression analysis, with each learner serving as his or her own control, senior residents (PGY2/3+s) who rated themselves relatively lower in a competency area were more likely to write a learning goal in that area than were PGY1s. Senior residents appear to develop better skills and/or motivation to explicitly turn self-assessed learning gaps into learning goals, suggesting that individualized learning plans may help improve self-regulated learning during residency. Copyright © 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Interactions Between Bacteria and the Gut Mucosa: Do Enteric Neurotransmitters Acting on the Mucosal Epithelium Influence Intestinal Colonization or Infection?

PubMed

Green, Benedict T; Brown, David R

2016-01-01

The intestinal epithelium is a critical barrier between the internal and external milieux of the mammalian host. Epithelial interactions between these two host environments have been shown to be modulated by several different, cross-communicating cell types residing in the gut mucosa. These include enteric neurons, whose activity is influenced by bacterial pathogens, and their secreted products. Neurotransmitters appear to influence epithelial associations with bacteria in the intestinal lumen. For example, internalization of Salmonella enterica and Escherichia coli O157:H7 into the Peyer's patch mucosa of the small intestine is altered after the inhibition of neural activity with saxitoxin, a neuronal sodium channel blocker. Catecholamine neurotransmitters, such as dopamine and norepinephrine, also alter bacterial internalization in Peyer's patches. In the large intestine, norepinephrine increases the mucosal adherence of E. coli. These neurotransmitter actions are mediated by well-defined catecholamine receptors situated on the basolateral membranes of epithelial cells rather than through direct interactions with luminal bacteria. Investigations of the involvement of neuroepithelial communication in the regulation of interactions between the intestinal mucosa and luminal bacteria will provide novel insights into the mechanisms underlying bacterial colonization and pathogenesis at mucosal surfaces.

Family medicine residency program directors' plans to incorporate maintenance of certification into residency training: a CERA survey.

PubMed

Peterson, Lars E; Blackburn, Brenna; Phillips, Robert L; Mainous, Arch G

2014-04-01

Participation in Maintenance of Certification for Family Physicians (MC-FP) is now a requirement for residents to take the American Board of Family Medicine (ABFM) certification examination. The objective of this study was to determine baseline use of MC-FP products prior to this requirement and assess how family medicine residency program directors (FMPD) intended to integrate MC-FP into residency education. We used the CERA platform to survey FMPDs. In addition to the core CERA demographic questions, we asked about the use of MC-FP in residency, how FMPDs intended to incorporate MC-FP, and how useful they believe MC-FP will be for resident evaluation. Additionally, we compared select results with the ABFM administrative database. A total of 224 FMPDs responded, for a 50.6% response rate. There was agreement between CERA and ABFM data on the percentage of residencies already using Part 4 modules (39.3% versus 38.8%) but not Part 2 modules (24.7% versus 62.8%). Group MC-FP activities were the preferred method for both Part 2 (45.0%) and Part 4 (54.4%). Most FMPDs agreed that MC-FP will be effective in teaching quality improvement and assessing competencies. Respondents from dually accredited programs were more likely to have used Part 4, but not Part 2, activities prior to 2012. Prior to MC-FP becoming a requirement in residency, a sizeable minority of residencies were already using these tools for education. Assessment of competencies will be crucial in the Next Accreditation System, and MC-FP may help in tracking clinical development over a physician's career.

The effect of gastric inhibitory polypeptide on intestinal glucose absorption and intestinal motility in mice

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ogawa, Eiichi; Hosokawa, Masaya; Faculty of Human Sciences, Tezukayama Gakuin University, Osaka

2011-01-07

Research highlights: {yields} Exogenous GIP inhibits intestinal motility through a somatostatin-mediated pathway. {yields} Exogenous GIP inhibits intestinal glucose absorption by reducing intestinal motility. {yields} The GIP-receptor-mediated action in intestine does not involve in GLP-1-mediated pathway. -- Abstract: Gastric inhibitory polypeptide (GIP) is released from the small intestine upon meal ingestion and increases insulin secretion from pancreatic {beta} cells. Although the GIP receptor is known to be expressed in small intestine, the effects of GIP in small intestine are not fully understood. This study was designed to clarify the effect of GIP on intestinal glucose absorption and intestinal motility. Intestinal glucosemore » absorption in vivo was measured by single-pass perfusion method. Incorporation of [{sup 14}C]-glucose into everted jejunal rings in vitro was used to evaluate the effect of GIP on sodium-glucose co-transporter (SGLT). Motility of small intestine was measured by intestinal transit after oral administration of a non-absorbed marker. Intraperitoneal administration of GIP inhibited glucose absorption in wild-type mice in a concentration-dependent manner, showing maximum decrease at the dosage of 50 nmol/kg body weight. In glucagon-like-peptide-1 (GLP-1) receptor-deficient mice, GIP inhibited glucose absorption as in wild-type mice. In vitro examination of [{sup 14}C]-glucose uptake revealed that 100 nM GIP did not change SGLT-dependent glucose uptake in wild-type mice. After intraperitoneal administration of GIP (50 nmol/kg body weight), small intestinal transit was inhibited to 40% in both wild-type and GLP-1 receptor-deficient mice. Furthermore, a somatostatin receptor antagonist, cyclosomatostatin, reduced the inhibitory effect of GIP on both intestinal transit and glucose absorption in wild-type mice. These results demonstrate that exogenous GIP inhibits intestinal glucose absorption by reducing intestinal motility through a

Isolation and Flow Cytometry Analysis of Innate Lymphoid Cells from the Intestinal Lamina Propria.

PubMed

Gronke, Konrad; Kofoed-Nielsen, Michael; Diefenbach, Andreas

2017-01-01

The intestinal mucosa constitutes the biggest surface area of the body. It is constantly challenged by bacteria, commensal and pathogenic, protozoa, and food-derived irritants. In order to maintain homeostasis, a complex network of signaling circuits has evolved that includes contributions of immune cells. In recent years a subset of lymphocytes, which belong to the innate immune system, has caught particular attention. These so-called innate lymphoid cells (ILC) reside within the lamina propria of the small and large intestines and rapidly respond to environmental challenges. They provide immunity to various types of infections but may also contribute to organ homeostasis as they produce factors acting on epithelial cells thereby enhancing barrier integrity. Here, we describe how these cells can be isolated from their environment and provide an in-depth protocol how to visualize the various ILC subsets by flow cytometry.

Providing rapid feedback to residents on their teaching skills: an educational strategy for contemporary trainees

PubMed Central

Baer, Tamar G.; Gershel, Jeffrey C.

2016-01-01

Objectives The objective of this study was to assess the attitudes of contemporary residents toward receiving rapid feedback on their teaching skills from their medical student learners. Methods Participants consisted of 20 residents in their second post-graduate training year. These residents facilitated 44 teaching sessions with medical students within our Resident-as-Teacher program. Structured, written feedback from students was returned to the resident within 3 days following each session. Residents completed a short survey about the utility of the feedback, whether they would make a change to future teaching sessions based on the feedback, and what specifically they might change. The survey utilized a 4-point scale (“Not helpful/likely=1” to “Very helpful/likely=4”), and allowed for one free-text response. Free-text responses were hand-coded and underwent qualitative analysis to identify themes.   Results There were 182 student feedback encounters resulting from 44 teaching sessions. The survey response rate was 73% (32/44). Ninety-four percent of residents rated the rapid feedback as “very helpful,” and 91% would “very likely” make a change to subsequent sessions based on student feedback. Residents’ proposed changes included modifications to session content and/or their personal teaching style.    Conclusions Residents found that rapid feedback received from medical student learners was highly valuable to them in their roles as teachers. A rapid feedback strategy may facilitate an optimal educational environment for contemporary trainees. PMID:26995390

Pathophysiology of avian intestinal ion transport.

PubMed

Nighot, Meghali; Nighot, Prashant

2018-06-01

The gut has great importance for the commercial success of poultry production. Numerous ion transporters, exchangers, and channels are present on both the apical and the basolateral membrane of intestinal epithelial cells, and their differential expression along the crypt-villus axis within the various intestinal segments ensures efficient intestinal absorption and effective barrier function. Recent studies have shown that intensive production systems, microbial exposure, and nutritional management significantly affect intestinal physiology and intestinal ion transport. Dysregulation of normal intestinal ion transport is manifested as diarrhoea, malabsorption, and intestinal inflammation resulting into poor production efficiency. This review discusses the basic mechanisms involved in avian intestinal ion transport and the impact of development during growth, nutritional and environmental alterations, and intestinal microbial infections on it. The effect of intestinal microbial infections on avian intestinal ion transport depends on factors such as host immunity, pathogen virulence, and the mucosal organisation of the particular intestinal segment.

Intestinal Parasitoses.

ERIC Educational Resources Information Center

Lagardere, Bernard; Dumburgier, Elisabeth

1994-01-01

Intestinal parasites have become a serious public health problem in tropical countries because of the climate and the difficulty of achieving efficient hygiene. The objectives of this journal issue are to increase awareness of the individual and collective repercussions of intestinal parasites, describe the current conditions of contamination and…

How to assess intestinal viability during surgery: A review of techniques

PubMed Central

Urbanavičius, Linas; Pattyn, Piet; Van de Putte, Dirk; Venskutonis, Donatas

2011-01-01

Objective and quantitative intraoperative methods of bowel viability assessment are essential in gastrointestinal surgery. Exact determination of the borderline of the viable bowel with the help of an objective test could result in a decrease of postoperative ischemic complications. An accurate, reproducible and cost effective method is desirable in every operating theater dealing with abdominal operations. Numerous techniques assessing various parameters of intestinal viability are described by the studies. However, there is no consensus about their clinical use. To evaluate the available methods, a systematic search of the English literature was performed. Virtues and drawbacks of the techniques and possibilities of clinical application are reviewed. Valuable parameters related to postoperative intestinal anastomotic or stoma complications are analyzed. Important issues in the measurement and interpretation of bowel viability are discussed. To date, only a few methods are applicable in surgical practice. Further studies are needed to determine the limiting values of intestinal tissue oxygenation and flow indicative of ischemic complications and to standardize the methods. PMID:21666808

[Surveillance of intestinal helminthiasis in Dafeng City from 2005 to 2010].

PubMed

Lu, Jian

2014-12-01

To understand the current status of intestinal helminth infections in Dafeng City. The residents in 5 villages of Dafeng City were investigated, and their stool samples were detected for the eggs of helminth with Kato-Katz technique, and Enterobius vermicularis was detected by the cellophane anal swab method. The total infection rates of intestinal helminth were 5.77%, 5.51%, 4.60%, 4.18%, 3.41%, and 1.38% from 2005 to 2010, respectively. The trend of total infection rates declined year by year. The infection rates in the 20-30 age-group and 60-80 age-group were higher than those in other age-groups. The infection rates of the male and female were 5.63% (359/6 375) and 2.42% (144/5 949), respectively, and there was a significant difference (χ2 = 74.81, P = 0.00). The infection rate (11.70%) in the northern areas of Dafeng City was higher than that in other places, and the trend of the infection rates decreased from the eastern and northern to the western and southern. The infection rate of E. vermicularis was 1.75% in children in 2010. The infection rate of intestinal helminth is low, but E. vermicularis infection is relatively general in the children in Dafeng City. Therefore, the prevention and treatment still need to be strengthened.

[Target chemotherapy of intestinal nematode infection in area with low endemicity].

PubMed

Zhang, Tao; Shen, Yi-ping; Liu, Ying; Yang, Wei-ping; Shao, Jing-ou; Ju, Shao-you; Dong, Kai; Xu, Ju-ling; Jiang, Ji-min

2002-01-01

To evaluate the control measures for intestinal nematodiasis in endemic area with low prevalence and intensity of infection. Target chemotherapy was carried out in high-risk population based on the epidemiological characteristics such as age and clinical findings. Albendazole and mebendazole were administered each 200 mg once daily every year for 3 or 5 years. Saturated brine floatation and Kato-Katz thick smear techniques were used for stool examination to evaluate the efficacy of treatment. Two hundred residents from each of the three investigation villages were selected for target chemotherapy once a year for three years. The prevalence of intestinal nematodes decreased from 6.2% in 1995 to 5.4% in 1996 and 3.2% in 1997, and remained at 2.3% after three years in 2000. One control village where only primary school students were treated once a year for 5 years, the prevalence of Ascaris and Trichuris infection also decreased from 1.4% and 4.2% in 1995 to 0.9% and 1.4% in 2000, respectively. The target chemotherapy on the predisposed population to hookworm infection showed that the prevalence in the population above 41 years old was declined from 19.4% to 10.9%. The target chemotherapy is an economical and effective approach for the control of intestinal nematode infection in endemic area with low prevalence and intensity of infection.

Intestinal development and differentiation

PubMed Central

Noah, Taeko K.; Donahue, Bridgitte; Shroyer, Noah F.

2011-01-01

In this review, we present an overview of intestinal development and cellular differentiation of the intestinal epithelium. The review is separated into two sections: Section one summarizes organogenesis of the small and large intestines, including endoderm and gut tube formation in early embryogenesis, villus morphogenesis, and crypt formation. Section two reviews cell fate specification and differentiation of each cell type within the intestinal epithelium. Growth factor and transcriptional networks that regulate these developmental processes are summarized. PMID:21978911

Intestinal lamina propria dendritic cells maintain T cell homeostasis but do not affect commensalism

PubMed Central

Welty, Nathan E.; Staley, Christopher; Ghilardi, Nico; Sadowsky, Michael J.; Igyártó, Botond Z.

2013-01-01

Dendritic cells (DCs) in the intestinal lamina propria (LP) are composed of two CD103+ subsets that differ in CD11b expression. We report here that Langerin is expressed by human LP DCs and that transgenic human langerin drives expression in CD103+CD11b+ LP DCs in mice. This subset was ablated in huLangerin-DTA mice, resulting in reduced LP Th17 cells without affecting Th1 or T reg cells. Notably, cognate DC–T cell interactions were not required for Th17 development, as this response was intact in huLangerin-Cre I-Aβfl/fl mice. In contrast, responses to intestinal infection or flagellin administration were unaffected by the absence of CD103+CD11b+ DCs. huLangerin-DTA x BatF3−/− mice lacked both CD103+ LP DC subsets, resulting in defective gut homing and fewer LP T reg cells. Despite these defects in LP DCs and resident T cells, we did not observe alterations of intestinal microbial communities. Thus, CD103+ LP DC subsets control T cell homeostasis through both nonredundant and overlapping mechanisms. PMID:24019552

Eosinophils may play regionally disparate roles in influencing IgA(+) plasma cell numbers during large and small intestinal inflammation.

PubMed

Forman, Ruth; Bramhall, Michael; Logunova, Larisa; Svensson-Frej, Marcus; Cruickshank, Sheena M; Else, Kathryn J

2016-05-31

eosinophils for maintaining IgA+ cells between the large and small intestine, which are more pronounced during inflammation. This is an important step towards further delineation of the enigmatic functions of gut-resident eosinophils.

[PULMONARY AND INTESTINAL TUBERCULOSIS DEVELOPING ACUTE TUBERCULOUS PERFORATION OF THE INTESTINE DURING ANTITUBERCULOSIS THERAPY].

PubMed

Saitou, Miwako; Suzuki, Tomoko; Niitsuma, Katsunao

2015-09-01

Intestinal tuberculosis (TB) was recognized as the most common complication with a high frequency of active pulmonary TB during the TB epidemic period. However, intestinal TB has become a rare disease, and intestinal perforation due to intestinal TB is extremely rare. We herein report two cases of tuberculous intestinal perforation. A 41-year-old man was admitted to our hospital complaining of persistent cough and anorexia. He was in poor nutritional condition, and his body mass index (BMI) and prognostic nutrition index (PNI) were 13.4 and 36.4, respectively. He was diagnosed with pulmonary TB and received anti-TB therapy. On the 51st day of hospitalization, he developed intestinal perforation. Pathologically caseating epithelioid granulomas were noted at the ulcer lesion. A 61-year-old man was admitted to our hospital due to miliary TB caused by intestinal TB. He had taken oral immunosuppressive drugs and steroids for dermatomyositis over the previous eight years and had a poor nutritional condition, with a BMI of 13.4 and a PNI of 14.4. While receiving anti-TB therapy, he developed intestinal perforation on the 97th day of hospitalization. The patient's poor nutritional condition and immune reconstitution may have contributed to the intestinal perforation.

Combating the stress of residency: one school's approach.

PubMed

Dabrow, Sharon; Russell, Stephen; Ackley, Karen; Anderson, Eric; Fabri, Peter Jeff

2006-05-01

Residency is a time of stress and turmoil for many residents. The stresses are varied and great, often involving both personal and professional issues. One institutional mechanism that has been shown to help residents cope with stress is the use of residents' wellness, or assistance, programs. The University of South Florida (USF) College of Medicine developed the USF Residency Assistance Program (RAP) in 1997, modeled after business employee assistance programs but tailored to enhance the well-being of residents. The program was developed in an organized, thoughtful manner starting with a Request for Proposals to all local employee assistance programs and the selection of one of these to run the program. The RAP is broad-based, readily available, easily accessible, totally voluntary and confidential, and not reportable to the state board of medicine. It is well integrated into all residency programs and has had excellent acceptance from the administration; information about access to the RAP is available to all residents through multiple venues. The cost is minimal, at only seven cents a day per resident. The authors present data from the eight years the RAP has been operating, including information on program use, referral rates, acceptance, and types of problems encountered. One suicide occurred during this time period, and the RAP provided a significant role in grief counseling. Assistance programs are critical to the well-being of residents. The USF program presents a model that can be used by other programs around the country.

Intestinal alkaline phosphatase is protective to the preterm rat pup intestine.

PubMed

Heinzerling, Nathan P; Liedel, Jennifer L; Welak, Scott R; Fredrich, Katherine; Biesterveld, Ben E; Pritchard, Kirkwood A; Gourlay, David M

2014-06-01

Necrotizing enterocolitis (NEC) is the most common surgical emergency in neonates, with a mortality rate between 10 and 50%. The onset of necrotizing enterocolitis is highly variable and associated with numerous risk factors. Prior research has shown that enteral supplementation with intestinal alkaline phosphatase (IAP) decreases the severity of NEC. The aim of this study is to investigate whether IAP is protective to the preterm intestine in the presence of formula feeding and in the absence of NEC. Preterm rat pups were fed formula with or without supplementation with IAP, and intestine was obtained on day of life 3 for analysis of IAP activity, mRNA expression of TNFα, IL-6 and iNOS and permeability and cytokine expression after LPS exposure. There was no difference in the absolute and intestine specific alkaline phosphatase activity in both groups. Rat pups fed IAP had decreased mRNA expression of the inflammatory cytokines TNFα, IL-6 and iNOS. Pups supplemented with IAP had decreased permeability and inflammatory cytokine expression after exposure to LPS ex vivo when compared to formula fed controls. Our results support that IAP is beneficial to preterm intestine and decreases intestinal injury and inflammation caused by LPS. Copyright © 2014 Elsevier Inc. All rights reserved.

Intestinal Alkaline Phosphatase Is Protective to the Preterm Rat Pup Intestine

PubMed Central

Heinzerling, Nathan P.; Liedel, Jennifer L.; Welak, Scott R.; Fredrich, Katherine; Biesterveld, Ben E.; Pritchard, Kirkwood A.; Gourlay, David M.

2014-01-01

Background Necrotizing enterocolitis (NEC) is the most common surgical emergency in neonates, with a mortality rate between 10 and 50%. The onset of necrotizing enterocolitis is highly variable and associated with numerous risk factors. Prior research has shown enteral supplementation with intestinal alkaline phosphatase (IAP) decreases the severity of NEC. The aim of this study is to investigate whether IAP is protective to the preterm intestine in the presence of formula feeding and in the absence of NEC. Methods Preterm rat pups were fed formula with or without supplementation with IAP, and intestine was obtained on day of life 3 for analysis of IAP activity, mRNA expression of TNF-a, IL-6 and iNOS and permeability and cytokine expression after LPS. exposure. Results There was no difference in the absolute and intestine specific alkaline phosphatase activity in both groups. Rat pups fed IAP had decreased mRNA expression of the inflammatory cytokines TNFα, IL-6 and iNOS. Pups supplemented with IAP had decreased permeability and inflammatory cytokine expression after exposure to LPS ex vivo when compared to formula fed controls. Conclusions Our results support that IAP is beneficial to preterm intestine and decreases intestinal injury and inflammation caused by LPS. PMID:24888842

The relationship between intestinal parasites and some immune-mediated intestinal conditions

PubMed Central

Mohammadi, Rasoul; Hosseini-Safa, Ahmad; Ehsani Ardakani, Mohammad Javad; Rostami-Nejad, Mohammad

2015-01-01

Over the last decades, the incidence of infestation by minor parasites has decreased in developed countries. Infectious agents can also suppress autoimmune and allergic disorders. Some investigations show that various protozoa and helminthes are connected with the main immune-mediated intestinal conditions including celiac disease (CD), inflammatory bowel diseases (IBD) and irritable bowel syndrome (IBS). Celiac disease is a digestive and autoimmune disorder that can damage the small intestine and characterized by a multitude gastrointestinal (GI) and extra GI symptoms. IBD (including ulcerative colitis and Crohn’s disease) is a group of inflammatory conditions of the small intestine and colon. The etiology of IBD is unknown, but it may be related to instability in the intestinal microflora that leading to an immoderate inflammatory response to commensal microbiota. Irritable bowel syndrome (IBS) is a common, long-term condition of the digestive system. Bloating, diarrhoea and/or constipation are nonspecific symptoms of IBS. Various studies have shown that some intestinal parasites can effect on immune system of infected hosts and in some cases, they are able to modify and change the host’s immune responses, particularly in autoimmune disorders like celiac disease and IBD. The main objective of this review is to investigate the relationship between intestinal parasites and different inflammatory bowel disorders. PMID:25926937

Intestinal Microbiota Influences Non-intestinal Related Autoimmune Diseases

PubMed Central

Opazo, Maria C.; Ortega-Rocha, Elizabeth M.; Coronado-Arrázola, Irenice; Bonifaz, Laura C.; Boudin, Helene; Neunlist, Michel; Bueno, Susan M.; Kalergis, Alexis M.; Riedel, Claudia A.

2018-01-01

The human body is colonized by millions of microorganisms named microbiota that interact with our tissues in a cooperative and non-pathogenic manner. These microorganisms are present in the skin, gut, nasal, oral cavities, and genital tract. In fact, it has been described that the microbiota contributes to balancing the immune system to maintain host homeostasis. The gut is a vital organ where microbiota can influence and determine the function of cells of the immune system and contributes to preserve the wellbeing of the individual. Several articles have emphasized the connection between intestinal autoimmune diseases, such as Crohn's disease with dysbiosis or an imbalance in the microbiota composition in the gut. However, little is known about the role of the microbiota in autoimmune pathologies affecting other tissues than the intestine. This article focuses on what is known about the role that gut microbiota can play in the pathogenesis of non-intestinal autoimmune diseases, such as Grave's diseases, multiple sclerosis, type-1 diabetes, systemic lupus erythematosus, psoriasis, schizophrenia, and autism spectrum disorders. Furthermore, we discuss as to how metabolites derived from bacteria could be used as potential therapies for non-intestinal autoimmune diseases. PMID:29593681

Anti-Infective Activities of Lactobacillus Strains in the Human Intestinal Microbiota: from Probiotics to Gastrointestinal Anti-Infectious Biotherapeutic Agents

PubMed Central

Liévin-Le Moal, Vanessa

2014-01-01

SUMMARY A vast and diverse array of microbial species displaying great phylogenic, genomic, and metabolic diversity have colonized the gastrointestinal tract. Resident microbes play a beneficial role by regulating the intestinal immune system, stimulating the maturation of host tissues, and playing a variety of roles in nutrition and in host resistance to gastric and enteric bacterial pathogens. The mechanisms by which the resident microbial species combat gastrointestinal pathogens are complex and include competitive metabolic interactions and the production of antimicrobial molecules. The human intestinal microbiota is a source from which Lactobacillus probiotic strains have often been isolated. Only six probiotic Lactobacillus strains isolated from human intestinal microbiota, i.e., L. rhamnosus GG, L. casei Shirota YIT9029, L. casei DN-114 001, L. johnsonii NCC 533, L. acidophilus LB, and L. reuteri DSM 17938, have been well characterized with regard to their potential antimicrobial effects against the major gastric and enteric bacterial pathogens and rotavirus. In this review, we describe the current knowledge concerning the experimental antibacterial activities, including antibiotic-like and cell-regulating activities, and therapeutic effects demonstrated in well-conducted, placebo-controlled, randomized clinical trials of these probiotic Lactobacillus strains. What is known about the antimicrobial activities supported by the molecules secreted by such probiotic Lactobacillus strains suggests that they constitute a promising new source for the development of innovative anti-infectious agents that act luminally and intracellularly in the gastrointestinal tract. PMID:24696432

A primary intestinal lymphangiectasia patient diagnosed by capsule endoscopy and confirmed at surgery: a case report.

PubMed

Fang, You-Hong; Zhang, Bing-Ling; Wu, Jia-Guo; Chen, Chun-Xiao

2007-04-21

Intestinal lymphangiectasia (IL) is a rare disease characterized by dilated lymphatic vessles in the intestinal wall and small bowel mesentery which induce loss of protein and lymphocytes into bowel lumen. Because it most often occurs in the intestine and cannot be detected by upper gastroendoscopy or colonoscopy, and the value of common image examinations such as X-ray and computerized tomography (CT) are limited, the diagnosis of IL is difficult, usually needing the help of surgery. Capsule endoscopy is useful in diagnosing intestinal diseases, such as IL. We here report a case of IL in a female patient who was admitted for the complaint of recurrent edema accompanied with diarrhea and abdominal pain over the last twenty years, and aggravated ten days ago. She was diagnosed by M2A capsule endoscopy as a primary IL and confirmed by surgical and pathological examination.

Apple-peel intestinal atresia: enteroplasty for intestinal lengthening and primary anastomosis.

PubMed

Onofre, Luciano Silveira; Maranhão, Renato Frota de Albuquerque; Martins, Elaine Cristina Soares; Fachin, Camila Girardi; Martins, Jose Luiz

2013-06-01

Apple-peel atresia (or Type-IIIb intestinal atresia) is an unusual type of jejunoileal atresia. They present with jejunal atresia near the ligament of Treitz and a foreshortened small bowel. Many surgical options have been used, but the optimal method of repair remains unclear. We present a case of a newborn with apple-peel intestinal atresia managed by enteroplasty for intestinal lengthening and primary anastomosis. Copyright © 2013 Elsevier Inc. All rights reserved.

Bacterial Population in Intestines of Litopenaeus vannamei Fed Different Probiotics or Probiotic Supernatant.

PubMed

Sha, Yujie; Liu, Mei; Wang, Baojie; Jiang, Keyong; Qi, Cancan; Wang, Lei

2016-10-28

The interactions of microbiota in the gut play an important role in promoting or maintaining the health of hosts. In this study, in order to investigate and compare the effects of dietary supplementation with Lactobacillus pentosus HC-2 (HC-2), Enterococcus faecium NRW-2, or the bacteria-free supernatant of a HC-2 culture on the bacterial composition of Litopenaeus vannamei , Illumina sequencing of the V1-V2 region of the 16S rRNA gene was used. The results showed that unique species exclusively existed in specific dietary groups, and the abundance of Actinobacteria was significantly increased in the intestinal bacterial community of shrimp fed with the bacteria-free supernatant of an HC-2 culture compared with the control. In addition, the histology of intestines of the shrimp from the four dietary groups was also described, but no obvious improvements in the intestinal histology were observed. The findings in this work will help to promote the understanding of the roles of intestinal bacteria in shrimps when fed with probiotics or probiotic supernatant.

[Investigation of major parasitic diseases and related knowledge, attitude and practice among rural residents in Liyang City].

PubMed

Yan-Li, Guo; Yong-Gen, Zou; Yi-Qing, Xie; Hong, Chen; Ming-Zhen, He; Lai-Fu, Lü; Li-Zhong, Huang; Xiao-Lin, Jin

2017-09-27

To investigate the prevalence of major parasitic diseases and related knowledge, attitude and practice among rural residents in Liyang City, so as to provide the evidence for formulating appropriate preventive strategies and measures. Three villages were selected from three towns as survey sites, and the residents who were above three years old and had been in the village for over six months were investigated. The Kato-Katz technique was applied to detect intestinal parasite eggs in residents' feces, and the cellophane anal swab was used to detect Enterobius vermicularis eggs among children aged 3-6 years. The iodine liquid smear and saline smear methods were used to examine intestinal protozoa cysts or trophozoites. Hookworm species were identified by the tube filter paper culture method. A structured questionnaire was used to collect the information on residents' knowledge, attitude and practice of the prevention and control of major parasitic diseases. Totally 759 residents were investigated and tested at the three rural survey sites, and only 2 cases were detected of parasitic infection and the total infection rate was 0.26%. Both cases were mild infections without mixed infection. The total awareness rate of knowledge on ascariasis, trichuriasis and ancylostomiasis was 37.9%, while the awareness rate of knowledge on clonorchiasis was 13.8%. The age and educational level were important factors of the knowledge on prevention and control of parasitic diseases among the residents. The formation rates of washing hands before meal and after using the toilet, and never drinking unboiled water were 83.8% and 92.1%, respectively. Totally 11.6% of the residents usually ate raw or half-cooked freshwater fishes and shrimps, and 53.0% had not the behavior to prepare raw and cooked food using the different chopping boards. The proportions of residents using fresh feces as manure and working in the field with bare feet were 13.8% and 22.8% respectively. The proportions of

Intestinal lymphangiectasia in children

PubMed Central

Isa, Hasan M.; Al-Arayedh, Ghadeer G.; Mohamed, Afaf M.

2016-01-01

Intestinal lymphangiectasia (IL) is a rare disease characterized by dilatation of intestinal lymphatics. It can be classified as primary or secondary according to the underlying etiology. The clinical presentations of IL are pitting edema, chylous ascites, pleural effusion, acute appendicitis, diarrhea, lymphocytopenia, malabsorption, and intestinal obstruction. The diagnosis is made by intestinal endoscopy and biopsies. Dietary modification is the mainstay in the management of IL with a variable response. Here we report 2 patients with IL in Bahrain who showed positive response to dietary modification. PMID:26837404

Pediatric Integrative Medicine in Residency Program: Relationship between Lifestyle Behaviors and Burnout and Wellbeing Measures in First-Year Residents.

PubMed

McClafferty, Hilary; Brooks, Audrey J; Chen, Mei-Kuang; Brenner, Michelle; Brown, Melanie; Esparham, Anna; Gerstbacher, Dana; Golianu, Brenda; Mark, John; Weydert, Joy; Yeh, Ann Ming; Maizes, Victoria

2018-04-23

It is widely recognized that burnout is prevalent in medical culture and begins early in training. Studies show pediatricians and pediatric trainees experience burnout rates comparable to other specialties. Newly developed Accreditation Council for Graduate Medical Education (ACGME) core competencies in professionalism and personal development recognize the unacceptably high resident burnout rates and present an important opportunity for programs to improve residents experience throughout training. These competencies encourage healthy lifestyle practices and cultivation of self-awareness, self-regulation, empathy, mindfulness, and compassion—a paradigm shift from traditional medical training underpinned by a culture of unrealistic endurance and self-sacrifice. To date, few successful and sustainable programs in resident burnout prevention and wellness promotion have been described. The University of Arizona Center for Integrative Medicine Pediatric Integrative Medicine in Residency (PIMR) curriculum, developed in 2011, was designed in part to help pediatric programs meet new resident wellbeing requirements. The purpose of this paper is to detail levels of lifestyle behaviors, burnout, and wellbeing for the PIMR program’s first-year residents ( N = 203), and to examine the impact of lifestyle behaviors on burnout and wellbeing. The potential of the PIMR to provide interventions addressing gaps in lifestyle behaviors with recognized association to burnout is discussed.

Institutional Focus and Non-Resident Student Enrollment

ERIC Educational Resources Information Center

Baryla, Edward A., Jr.; Dotterweich, Douglas

2006-01-01

Purpose: This paper uses institutional characteristics and regional economic data to determine if institutional mission may help drive non-resident undergraduate enrollment. Design/methodology/approach: A two-stage least squares regression models is employed on 180 Doctoral, 333 Comprehensive, and 501 Baccalaureate higher education institutions to…

Immunohistochemical and ultrastructural evidence of functional organization along the Corydoras paleatus intestine.

PubMed

Plaul, Silvia E; Pastor, Raquel; Díaz, Alcira O; Barbeito, Claudio G

2016-03-01

The Neotropical catfish, Corydoras paleatus (Callichthyidae) is a facultative air-breathing teleost that makes use of the caudal portion of the intestine as an accessory air-breathing organ. This portion is highly modified, being well vascularized with capillaries between epithelial cells, which makes it well suited for gas exchange. Instead, the cranial portion is a digestion and absorption site, as it has a typical intestinal epithelium with columnar cells arranged in a single row, villi and less vascularized tunica mucosa. Therefore, the intestine was studied by light and electron microscopy to assess differences between the cranial, middle and caudal portions. To characterize the potential for cell proliferation of this organ, we used anti-proliferating cell nuclear antigen antibody and anti-Na(+) K(+) -ATPase monoclonal antibody to detect the presence of Na(+) /K(+) pump. In C. paleatus it was observed that cell dynamics showed a decreasing gradient of proliferation in cranio-caudal direction. Also, the intestine of this catfish is an important organ in ionoregulation: the basolateral Na(+) /K(+) pump may have an active role, transporting Na(+) out of the cell while helping to maintain the repose potential and to regulate cellular volume. © 2016 Wiley Periodicals, Inc.

The Extracellular Calcium-Sensing Receptor in the Intestine: Evidence for Regulation of Colonic Absorption, Secretion, Motility, and Immunity.

PubMed

Tang, Lieqi; Cheng, Catherine Y; Sun, Xiangrong; Pedicone, Alexandra J; Mohamadzadeh, Mansour; Cheng, Sam X

2016-01-01

Different from other epithelia, the intestinal epithelium has the complex task of providing a barrier impeding the entry of toxins, food antigens, and microbes, while at the same time allowing for the transfer of nutrients, electrolytes, water, and microbial metabolites. These molecules/organisms are transported either transcellularly, crossing the apical and basolateral membranes of enterocytes, or paracellularly, passing through the space between enterocytes. Accordingly, the intestinal epithelium can affect energy metabolism, fluid balance, as well as immune response and tolerance. To help accomplish these complex tasks, the intestinal epithelium has evolved many sensing receptor mechanisms. Yet, their roles and functions are only now beginning to be elucidated. This article explores one such sensing receptor mechanism, carried out by the extracellular calcium-sensing receptor (CaSR). In addition to its established function as a nutrient sensor, coordinating food digestion, nutrient absorption, and regulating energy metabolism, we present evidence for the emerging role of CaSR in the control of intestinal fluid homeostasis and immune balance. An additional role in the modulation of the enteric nerve activity and motility is also discussed. Clearly, CaSR has profound effects on many aspects of intestinal function. Nevertheless, more work is needed to fully understand all functions of CaSR in the intestine, including detailed mechanisms of action and specific pathways involved. Considering the essential roles CaSR plays in gastrointestinal physiology and immunology, research may lead to a translational opportunity for the development of novel therapies that are based on CaSR's unique property of using simple nutrients such as calcium, polyamines, and certain amino acids/oligopeptides as activators. It is possible that, through targeting of intestinal CaSR with a combination of specific nutrients, oral solutions that are both inexpensive and practical may be

The Extracellular Calcium-Sensing Receptor in the Intestine: Evidence for Regulation of Colonic Absorption, Secretion, Motility, and Immunity

PubMed Central

Tang, Lieqi; Cheng, Catherine Y.; Sun, Xiangrong; Pedicone, Alexandra J.; Mohamadzadeh, Mansour; Cheng, Sam X.

2016-01-01

Different from other epithelia, the intestinal epithelium has the complex task of providing a barrier impeding the entry of toxins, food antigens, and microbes, while at the same time allowing for the transfer of nutrients, electrolytes, water, and microbial metabolites. These molecules/organisms are transported either transcellularly, crossing the apical and basolateral membranes of enterocytes, or paracellularly, passing through the space between enterocytes. Accordingly, the intestinal epithelium can affect energy metabolism, fluid balance, as well as immune response and tolerance. To help accomplish these complex tasks, the intestinal epithelium has evolved many sensing receptor mechanisms. Yet, their roles and functions are only now beginning to be elucidated. This article explores one such sensing receptor mechanism, carried out by the extracellular calcium-sensing receptor (CaSR). In addition to its established function as a nutrient sensor, coordinating food digestion, nutrient absorption, and regulating energy metabolism, we present evidence for the emerging role of CaSR in the control of intestinal fluid homeostasis and immune balance. An additional role in the modulation of the enteric nerve activity and motility is also discussed. Clearly, CaSR has profound effects on many aspects of intestinal function. Nevertheless, more work is needed to fully understand all functions of CaSR in the intestine, including detailed mechanisms of action and specific pathways involved. Considering the essential roles CaSR plays in gastrointestinal physiology and immunology, research may lead to a translational opportunity for the development of novel therapies that are based on CaSR's unique property of using simple nutrients such as calcium, polyamines, and certain amino acids/oligopeptides as activators. It is possible that, through targeting of intestinal CaSR with a combination of specific nutrients, oral solutions that are both inexpensive and practical may be

Mixed reality ventriculostomy simulation: experience in neurosurgical residency.

PubMed

Hooten, Kristopher G; Lister, J Richard; Lombard, Gwen; Lizdas, David E; Lampotang, Samsun; Rajon, Didier A; Bova, Frank; Murad, Gregory J A

2014-12-01

Medicine and surgery are turning toward simulation to improve on limited patient interaction during residency training. Many simulators today use virtual reality with augmented haptic feedback with little to no physical elements. In a collaborative effort, the University of Florida Department of Neurosurgery and the Center for Safety, Simulation & Advanced Learning Technologies created a novel "mixed" physical and virtual simulator to mimic the ventriculostomy procedure. The simulator contains all the physical components encountered for the procedure with superimposed 3-D virtual elements for the neuroanatomical structures. To introduce the ventriculostomy simulator and its validation as a necessary training tool in neurosurgical residency. We tested the simulator in more than 260 residents. An algorithm combining time and accuracy was used to grade performance. Voluntary postperformance surveys were used to evaluate the experience. Results demonstrate that more experienced residents have statistically significant better scores and completed the procedure in less time than inexperienced residents. Survey results revealed that most residents agreed that practice on the simulator would help with future ventriculostomies. This mixed reality simulator provides a real-life experience, and will be an instrumental tool in training the next generation of neurosurgeons. We have now implemented a standard where incoming residents must prove efficiency and skill on the simulator before their first interaction with a patient.

Intestinal pseudo-obstruction

MedlinePlus

... Staying in bed for long periods of time (bedridden). Taking drugs that slow intestinal movements. These include ... be tried: Colonoscopy may be used to remove air from the large intestine. Fluids can be given ...

The Roles of Glutamine in the Intestine and Its Implication in Intestinal Diseases

PubMed Central

Kim, Min-Hyun; Kim, Hyeyoung

2017-01-01

Glutamine, the most abundant free amino acid in the human body, is a major substrate utilized by intestinal cells. The roles of glutamine in intestinal physiology and management of multiple intestinal diseases have been reported. In gut physiology, glutamine promotes enterocyte proliferation, regulates tight junction proteins, suppresses pro-inflammatory signaling pathways, and protects cells against apoptosis and cellular stresses during normal and pathologic conditions. As glutamine stores are depleted during severe metabolic stress including trauma, sepsis, and inflammatory bowel diseases, glutamine supplementation has been examined in patients to improve their clinical outcomes. In this review, we discuss the physiological roles of glutamine for intestinal health and its underlying mechanisms. In addition, we discuss the current evidence for the efficacy of glutamine supplementation in intestinal diseases. PMID:28498331

Ex Vivo and In Situ Evaluation of 'Dispelling-Wind' Chinese Medicine Herb-Drugs on Intestinal Absorption of Chlorogenic Acid.

PubMed

Zhai, Lixiang; Shi, Jun; Xu, Weitong; Heinrich, Michael; Wang, Jianying; Deng, Wenji

2015-12-01

This study aims to investigate the additive or synergistic effects and mechanism of intestinal absorption of extracts from two commonly used 'dispelling-wind' TCM botanical drugs [roots of Angelica dahurica (Hoffm.) Benth. & Hook. f. ex Franch. & Sav. (RAD) and Saposhnikovia divaricata (Turcz.) Schischk. (RSD)] using chlorogenic acid as a marker substance. Ex vivo everted intestinal sac and in situ single pass perfusion methods using rats were employed to investigate the effects of two TCM botanical drugs extracts on the intestinal absorption of chlorogenic acid. Both the extracts of RAD and RSD showed synergistic properties on the intestinal absorption of chlorogenic acid. The verapamil (a P-gp inhibitor) and intestinal dysbacteriosis model induced by norfloxacin increased the P(app) and K(a) of intestinal absorption of chlorogenic acid. These synergistic effects on intestinal absorption in a rat model can be correlated with the inhibition of P-gp and regulation of gut microbiota. This experimental approach has helped to better understand changes in the absorption of chlorogenic acid under different conditions. Copyright © 2015 John Wiley & Sons, Ltd.

Identification of Diet-Derived Constituents as Potent Inhibitors of Intestinal Glucuronidation

PubMed Central

Gufford, Brandon T.; Chen, Gang; Lazarus, Philip; Graf, Tyler N.; Oberlies, Nicholas H.

2014-01-01

Drug-metabolizing enzymes within enterocytes constitute a key barrier to xenobiotic entry into the systemic circulation. Furanocoumarins in grapefruit juice are cornerstone examples of diet-derived xenobiotics that perpetrate interactions with drugs via mechanism-based inhibition of intestinal CYP3A4. Relative to intestinal CYP3A4-mediated inhibition, alternate mechanisms underlying dietary substance–drug interactions remain understudied. A working systematic framework was applied to a panel of structurally diverse diet-derived constituents/extracts (n = 15) as inhibitors of intestinal UDP-glucuronosyl transferases (UGTs) to identify and characterize additional perpetrators of dietary substance–drug interactions. Using a screening assay involving the nonspecific UGT probe substrate 4-methylumbelliferone, human intestinal microsomes, and human embryonic kidney cell lysates overexpressing gut-relevant UGT1A isoforms, 14 diet-derived constituents/extracts inhibited UGT activity by >50% in at least one enzyme source, prompting IC50 determination. The IC50 values of 13 constituents/extracts (≤10 μM with at least one enzyme source) were well below intestinal tissue concentrations or concentrations in relevant juices, suggesting that these diet-derived substances can inhibit intestinal UGTs at clinically achievable concentrations. Evaluation of the effect of inhibitor depletion on IC50 determination demonstrated substantial impact (up to 2.8-fold shift) using silybin A and silybin B, two key flavonolignans from milk thistle (Silybum marianum) as exemplar inhibitors, highlighting an important consideration for interpretation of UGT inhibition in vitro. Results from this work will help refine a working systematic framework to identify dietary substance–drug interactions that warrant advanced modeling and simulation to inform clinical assessment. PMID:25008344

Meeting the religious needs of residents with dementia.

PubMed

Higgins, Patricia

2013-11-01

This article considers practical strategies to help nurses working in care homes meet the religious needs of people with dementia, including attending services in homes or churches, supporting them in private prayer and at the end of life. It also considers the characteristics of person-centred care for such residents and how the Mental Capacity Act 2005 may be called on to support religious needs as dementia advances. To achieve good practice in all these aspects, staff in care homes should work in partnership with local faith communities and ensure they are aware of residents' life histories and preferences, including their faith practices. The focus of the article is on meeting the needs of Christian residents. For residents from other faith groups living in care homes not affiliated to their faith, the same general approach to meeting religious needs could be adopted as a starting point.

Assessing experiential education factors contributing to a PGY1 residency match: Pharmacy residency program director and comparative student survey.

PubMed

Prisco, Jennifer L; Hritcko, Philip M; Feret, Brett; Yorra, Mark L; Todd, Noreen E; Kim Tanzer; Basile, Cathy; Bonaceto, Kara; Morelli, Rita; Carace, Nicole; Szumita, Andrew

2018-02-01

To compare and contrast experiential education perceptions of pharmacy residency program directors (RPDs) and doctor of pharmacy students in their last year of the curriculum for residency application considerations. The New England Regional Departments of Experiential Education (NERDEE) consortium developed a 17-question survey to assess residency factors, including those related to experiential education. The survey was dispersed to advanced pharmacy practice experience (APPE) students from six colleges/schools of pharmacy and RPDs nationwide. Students have different values on experiential preferences compared to RPDs. Sample findings include internal medicine and specialty clinical elective experiences prior to American Society of Health-System Pharmacists (ASHP) Midyear were extremely important to important for students, while RPDs viewed these experiences as somewhat important at best (p < 0.02). The majority of RPDs (67%) have no APPE schedule preference, while most students (77%) feel that certain APPE schedules may influence acceptance into residency. Based on findings, information outlined can be used to dispel and/or validate common beliefs held by students regarding experiential factors that help or hinder a successful postgraduate year 1 (PGY1) residency match. Copyright © 2017 Elsevier Inc. All rights reserved.

PDA usage and training: targeting curriculum for residents and faculty.

PubMed

Morris, Carl G; Church, Lili; Vincent, Chris; Rao, Ashwin

2007-06-01

Utilization of personal digital assistants (PDAs) in residency education is common, but information about their use and how residents are trained to use them is limited. Better understanding of resident and faculty PDA use and training is needed. We used a cross-sectional survey of 598 residents and faculty from the WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho) Family Medicine Residency Network regarding PDA usage and training. Use of PDAs is common among residents (94%) and faculty (79%). Ninety-six percent of faculty and residents report stable or increasing frequency of use over time. The common barriers to PDA use relate to lack of time, knowledge, and formal education. Approximately half of PDA users (52%) have received some formal training; however, the majority of users report being self-taught. Faculty and residents prefer either small-group or one-on-one settings with hands-on, self-directed, interactive formats for PDA training. Large-group settings in lecture, written, or computer program formats were considered less helpful or desirable. PDAs have become a commonly used clinical tool. Lack of time and adequate training present a barrier to optimal application of PDAs in family medicine residency education.

Mental health literacy as a function of remoteness of residence: an Australian national study.

PubMed

Griffiths, Kathleen M; Christensen, Helen; Jorm, Anthony F

2009-03-27

Although there have been many population studies of mental health literacy, little is known about the mental health literacy of people who reside in rural areas. This study sought to determine the impact of remoteness on public knowledge of depression and schizophrenia. The mental health literacy of residents of major cities, inner regional, and outer-remote (including outer regional, remote, and very remote) regions were compared using data from a 2003-04 Australian national survey of the mental health literacy of 3998 adults. Measures included the perceived helpfulness of a range of professionals, non-professionals and interventions, and the causes, prognosis, and outcomes after treatment for four case vignettes describing depression, depression with suicidal ideation, early schizophrenia and chronic schizophrenia. Participant awareness of Australia's national depression initiative and depression in the media, their symptoms of depression and exposure to the conditions depicted in the vignettes were also compared. Mental health literacy was similar across remoteness categories. However, inner regional residents showed superior identification of the disorders depicted in the suicidal ideation and chronic schizophrenia vignettes. They were also more likely to report having heard of Australia's national depression health promotion campaign. Conversely, they were less likely than major city residents to rate the evidence-based treatment of psychotherapy helpful for depression. Both inner regional and outer-remote residents were less likely to rate psychologists as helpful for depression alone. The rural groups were more likely to rate the non-evidence based interventions of drinking and painkillers as helpful for a depression vignette. In addition, outer-remote residents were more likely to identify the evidence based treatment of antipsychotics as harmful for early schizophrenia and less likely to endorse psychiatrists, psychologists, social workers and general

Mental health literacy as a function of remoteness of residence: an Australian national study

PubMed Central

Griffiths, Kathleen M; Christensen, Helen; Jorm, Anthony F

2009-01-01

Background Although there have been many population studies of mental health literacy, little is known about the mental health literacy of people who reside in rural areas. This study sought to determine the impact of remoteness on public knowledge of depression and schizophrenia. Methods The mental health literacy of residents of major cities, inner regional, and outer-remote (including outer regional, remote, and very remote) regions were compared using data from a 2003–04 Australian national survey of the mental health literacy of 3998 adults. Measures included the perceived helpfulness of a range of professionals, non-professionals and interventions, and the causes, prognosis, and outcomes after treatment for four case vignettes describing depression, depression with suicidal ideation, early schizophrenia and chronic schizophrenia. Participant awareness of Australia's national depression initiative and depression in the media, their symptoms of depression and exposure to the conditions depicted in the vignettes were also compared. Results Mental health literacy was similar across remoteness categories. However, inner regional residents showed superior identification of the disorders depicted in the suicidal ideation and chronic schizophrenia vignettes. They were also more likely to report having heard of Australia's national depression health promotion campaign. Conversely, they were less likely than major city residents to rate the evidence-based treatment of psychotherapy helpful for depression. Both inner regional and outer-remote residents were less likely to rate psychologists as helpful for depression alone. The rural groups were more likely to rate the non-evidence based interventions of drinking and painkillers as helpful for a depression vignette. In addition, outer-remote residents were more likely to identify the evidence based treatment of antipsychotics as harmful for early schizophrenia and less likely to endorse psychiatrists, psychologists

Small Intestine Disorders

MedlinePlus

Your small intestine is the longest part of your digestive system - about twenty feet long! It connects your stomach ... many times to fit inside your abdomen. Your small intestine does most of the digesting of the ...

Is past academic productivity predictive of radiology resident academic productivity?

PubMed

Patterson, Stephanie K; Fitzgerald, James T; Boyse, Tedric D; Cohan, Richard H

2002-02-01

The authors performed this study to determine whether academic productivity in college and medical school is predictive of the number of publications produced during radiology residency. The authors reviewed the records of 73 radiology residents who completed their residency from 1990 to 2000. Academic productivity during college, medical school, and radiology residency, other postgraduate degrees, and past careers other than radiology were tabulated. The personal essay attached to the residency application was reviewed for any stated academic interest. Residents were classified as being either previously productive or previously unproductive. Publication rates during residency and immediately after residency were compared for the two groups. For the productive residents, a correlation analysis was used to examine the relationship between past frequency of publication and type of previous activity. Least-squares regression analysis was used to investigate the relationship between preresidency academic productivity, advanced degrees, stated interest in academics, and other careers and radiology residency publications. There was no statistically significant difference in the number of articles published by those residents who were active and those who were not active before residency (P = .21). Only authorship of papers as an undergraduate was weakly predictive of residency publication. These selected measures of academic productivity as an undergraduate and during medical school are not helpful for predicting publication during residency. There was no difference in publication potential between those residents who were academically productive in the past and those who were not.

Pine Ridge Indian Health Service Primary Care Resident Rotation: a summary.

PubMed

Jerde, O M; Vogt, H B

1996-10-01

The Pine Ridge Indian Health Service Primary Care Resident Rotation was officially established in January 1992 and operated through May 1996. Sponsored by an Indian Health Service grant, the rotation was conceived in an effort to help address the problem of recruitment and retention of physicians at Pin Ridge in the long term, while offering a unique educational experience for residents. Fifty-eight residents from 40 Family Practice, General Internal Medicine and General Pediatric Residency Programs in 18 states completed the rotation. Four of the rotation "graduates" are currently employed by the IHS at Pine Ridge and two other sites. A fifth physician provided short term service to a fourth site.

Use of pulse oximeter placed on a gastroschisis silo to monitor intestinal oxygen saturation.

PubMed

Kim, Sunghoon; Betts, James; Yedlin, Steve; Rowe, Richard; Idowu, Olajire

2006-09-01

The use of a silo for temporary coverage of exposed viscera for newborns with gastroschisis has allowed gradual reduction of the externalized intestine into the abdominal cavity. However, there has not been an easy way to monitor blood perfusion to the intestine within the silo other than with visual examination. In addition, visual examination of bowel through the silo is sometimes difficult for medical staff due to serositis and peel over the bowel. We have adopted an approach to monitor oxygen saturation of silo-contained intestine by placing a pulse oximeter sensor on the surface of the transparent silo to detect intestinal ischemia. Pulse oximeter sensors were applied on both a patient's distal extremity and the silo on five consecutive patients who were born with gastroschisis. The sensor was left on the silo during the entire period of gradual reduction. Perfusion index, pulse and oxygen saturation were observed and checked against the sensor placed on a peripheral extremity. The silo-placed pulse oximeter and peripheral pulse oximeter sensors showed a similar pulse and oxygen saturation throughout the reduction period in all five patients. In general, perfusion index was higher from the silo pulse oximeter compared to the peripheral pulse oximeter reading. A pulse oximeter can be used to monitor intestinal oxygen saturation contained within a silo and help modulate the rate of manual reduction of intestine.

Expression of an intestine-specific transcription factor (CDX1) in intestinal metaplasia and in subsequently developed intestinal type of cholangiocarcinoma in rat liver.

PubMed

Ren, P; Silberg, D G; Sirica, A E

2000-02-01

CDX1 is a caudal-type homeobox intestine-specific transcription factor that has been shown to be selectively expressed in epithelial cells in intestinal metaplasia of the human stomach and esophagus and variably expressed in human gastric and esophageal adenocarcinomas (Silberg DG, Furth EE, Taylor JK, Schuck T, Chiou T, Traber PG: Gastroenterology 1997, 113: 478-486). Through the use of immunohistochemistry and Western blotting, we investigated whether CDX1 is also uniquely associated with the intestinal metaplasia associated with putative precancerous cholangiofibrosis induced in rat liver during furan cholangiocarcinogenesis, as well as expressed in neoplastic glands in a subsequently developed intestinal type of cholangiocarcinoma. In normal, control adult rat small intestine, specific nuclear immunoreactivity for CDX1 was most prominent in enterocytes lining the crypts. In comparison, epithelium from intestinal metaplastic glands within furan-induced hepatic cholangiofibrosis and neoplastic epithelium from later developed primary intestinal-type cholangiocarcinoma each demonstrated strong nuclear immunoreactivity for CDX1. CDX1-positive cells were detected in hepatic cholangiofibrotic tissue as early as 3 weeks after the start of chronic furan treatment. We further determined that the percentages of CDX1-positive neoplastic glands and glandular nuclei are significantly higher in primary tumors than in a derived, transplantable cholangiocarcinoma serially-propagated in vivo. Western blotting confirmed our immunohistochemical results, and no CDX1 immunoreactivity was detected in normal adult rat liver or in hyperplastic biliary epithelial cells. These findings indicate that CDX1 is specifically associated with early intestinal metaplasia and a later developed intestinal-type of cholangiocarcinoma induced in the liver of furan-treated rats.

Problem-based learning in laboratory medicine resident education: a satisfaction survey.

PubMed

Lepiller, Quentin; Solis, Morgane; Velay, Aurélie; Gantner, Pierre; Sueur, Charlotte; Stoll-Keller, Françoise; Barth, Heidi; Fafi-Kremer, Samira

2017-04-01

Theoretical knowledge in biology and medicine plays a substantial role in laboratory medicine resident education. In this study, we assessed the contribution of problem-based learning (PBL) to improve the training of laboratory medicine residents during their internship in the department of virology, Strasbourg University Hospital, France. We compared the residents' satisfaction regarding an educational program based on PBL and a program based on lectures and presentations. PBL induced a high level of satisfaction (100%) among residents compared to lectures and presentations (53%). The main advantages of this technique were to create a situational interest regarding virological problems, to boost the residents' motivation and to help them identify the most relevant learning objectives in virology. However, it appears pertinent to educate the residents in appropriate bibliographic research techniques prior to PBL use and to monitor their learning by regular formative assessment sessions.

The role of simulation training in anesthesiology resident education.

PubMed

Yunoki, Kazuma; Sakai, Tetsuro

2018-06-01

An increasing number of reports indicate the efficacy of simulation training in anesthesiology resident education. Simulation education helps learners to acquire clinical skills in a safe learning environment without putting real patients at risk. This useful tool allows anesthesiology residents to obtain medical knowledge and both technical and non-technical skills. For faculty members, simulation-based settings provide the valuable opportunity to evaluate residents' performance in scenarios including airway management and regional, cardiac, and obstetric anesthesiology. However, it is still unclear what types of simulators should be used or how to incorporate simulation education effectively into education curriculums. Whether simulation training improves patient outcomes has not been fully determined. The goal of this review is to provide an overview of the status of simulation in anesthesiology resident education, encourage more anesthesiologists to get involved in simulation education to propagate its influence, and stimulate future research directed toward improving resident education and patient outcomes.

A primary intestinal lymphangiectasia patient diagnosed by capsule endoscopy and confirmed at surgery: A case report

PubMed Central

Fang, You-Hong; Zhang, Bing-Ling; Wu, Jia-Guo; Chen, Chun-Xiao

2007-01-01

Intestinal lymphangiectasia (IL) is a rare disease characterized by dilated lymphatic vessles in the intestinal wall and small bowel mesentery which induce loss of protein and lymphocytes into bowel lumen. Because it most often occurs in the intestine and cannot be detected by upper gastroendoscopy or colonoscopy, and the value of common image examinations such as X-ray and computerized tomography (CT) are limited, the diagnosis of IL is difficult, usually needing the help of surgery. Capsule endoscopy is useful in diagnosing intestinal diseases, such as IL. We here report a case of IL in a female patient who was admitted for the complaint of recurrent edema accompanied with diarrhea and abdominal pain over the last twenty years, and aggravated ten days ago. She was diagnosed by M2A capsule endoscopy as a primary IL and confirmed by surgical and pathological examination. PMID:17465517

[Life project of residents and institutional approach in nursing homes].

PubMed

Chanut, Corinne

The life project in a nursing home involves all the players concerned: first of all, the resident, then the caregivers, the families and the institution. This unifying tool, organised around the elderly, helps to develop collective competencies, favours the integration of new residents and reassures families. This article presents a nursing home's experience of setting up a life project. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Increasing resident recruitment into family medicine: effect of a unique curriculum in integrative medicine.

PubMed

Lebensohn, Patricia; Dodds, Sally; Brooks, Audrey J; Cook, Paula; Guerrera, Mary; Sierpina, Victor; Teets, Raymond; Woytowicz, John; Maizes, Victoria

2014-01-01

Healthcare reform is highlighting the need for more family practice and other primary care physicians. The Integrative Medicine in Residency (IMR) curriculum project helped family medicine residencies pilot a new, online curriculum promoting prevention, patient-centered care competencies, use of complementary and alternative medicine along with conventional medicine for management of chronic illness. A major potential benefit of the IMR program is enhanced recruitment into participating residencies, which is reported here. Using an online questionnaire, accepted applicants to the eight IMR pilot programs (n = 152) and four control programs (n = 50) were asked about their interests in learning integrative medicine (IM) and in the pilot sites how the presence of the IMR curriculum affected their ranking decisions. Of residents at the IMR sites, 46.7% reported that the presence of the IMR was very important or important in their ranking decision. The IMR also ranked fourth overall in importance of ranking after geography, quality of faculty, and academic reputation of the residency. The majority of IMR residents (87.5%) had high to moderate interest in learning IM during their residency; control residents also had a high interest in learning IM (61.2%). The presence of the IMR curriculum was seen as a strong positive by applicants in ranking residencies. Increasing the adoption of innovative IM curricula, such as the IMR, by residency programs may be helpful in increasing applications of competitive medical students into primary care residencies as well as in responding to the expressed interest in learning the IM approach to patient care. Copyright © 2014. Published by Elsevier Inc.

Intestinal tuft cells regulate the ATM mediated DNA Damage response via Dclk1 dependent mechanism for crypt restitution following radiation injury.

PubMed

Chandrakesan, Parthasarathy; May, Randal; Weygant, Nathaniel; Qu, Dongfeng; Berry, William L; Sureban, Sripathi M; Ali, Naushad; Rao, Chinthalapally; Huycke, Mark; Bronze, Michael S; Houchen, Courtney W

2016-11-23

Crypt epithelial survival and regeneration after injury require highly coordinated complex interplay between resident stem cells and diverse cell types. The function of Dclk1 expressing tuft cells regulating intestinal epithelial DNA damage response for cell survival/self-renewal after radiation-induced injury is unclear. Intestinal epithelial cells (IECs) were isolated and purified and utilized for experimental analysis. We found that small intestinal crypts of Villin Cre ;Dclk1 f/f mice were hypoplastic and more apoptotic 24 h post-total body irradiation, a time when stem cell survival is p53-independent. Injury-induced ATM mediated DNA damage response, pro-survival genes, stem cell markers, and self-renewal ability for survival and restitution were reduced in the isolated intestinal epithelial cells. An even greater reduction in these signaling pathways was observed 3.5 days post-TBI, when peak crypt regeneration occurs. We found that interaction with Dclk1 is critical for ATM and COX2 activation in response to injury. We determined that Dclk1 expressing tuft cells regulate the whole intestinal epithelial cells following injury through paracrine mechanism. These findings suggest that intestinal tuft cells play an important role in regulating the ATM mediated DNA damage response, for epithelial cell survival/self-renewal via a Dclk1 dependent mechanism, and these processes are indispensable for restitution and function after severe radiation-induced injury.

Resident transitions to assisted living: a role for social workers.

PubMed

Fields, Noelle LeCrone; Koenig, Terry; Dabelko-Schoeny, Holly

2012-08-01

This study explored key aspects of resident transitions to assisted living (AL), including the frequency and importance of preadmission resident education and the potential role of social workers in this setting. To examine the factors that may help or hinder resident transitions to AL, a written survey was administered to a statewide, geographically representative purposive sample of Medicaid Assisted Living Waiver providers (N = 28). Findings suggest a positive relationship between the availability of a social worker and the frequency and importance of resident preadmission education in several areas. Results also suggest a gap between what AL providers believe is important for resident transitions and what is actually happening in their facilities. Social workers may play a significant role in providing preadmission education and are well positioned to address the unmet psychosocial needs of residents and family members during the transition to AL. Future studies should specifically examine the contributing role of social workers during the period of adjustment to AL and the effect of social work services on the well-being of AL residents and families in AL settings.

Monosodium L-Glutamate and Dietary Fat Differently Modify the Composition of the Intestinal Microbiota in Growing Pigs

PubMed Central

Feng, Ze-Meng; Li, Tie-Jun; Wu, Li; Xiao, Ding-Fu; Blachier, Francois; Yin, Yu-Long

2015-01-01

Background The Chinese have been undergone rapid transition to a high-fat diet-consuming lifestyle, while monosodium L-glutamate (MSG) is widely used as a daily food additive. It has been reported that fat alters the composition of intestinal microbiota. However, little information is available on the effects of oral MSG on intestinal microbiota, and no study was done focusing on the interaction effect of fat and MSG with respect to intestinal microbiota. The present study thus aimed to determine the effects of MSG and/or fat on intestinal microbiota, and also to identify possible interactions between these two nutrients. Methods Four iso-nitrogenous and iso-caloric diets were provided to growing pigs. The microbiota from jejunum, ileum, cecum, and colon were analyzed. Results Our results show that both MSG and fat clearly increased the intestinal microbiota diversity. MSG and fat modified the composition of intestinal microbiota, particularly in the colon. Both MSG and fat promoted the colonization of microbes related to energy extraction in gastrointestinal tract via different ways. MSG promoted the colonization of Faecalibacterium prausnitzii and Roseburia, while fat increased the percentage of Prevotella in colon and other intestinal segments. Conclusion Our results will help to understand how individual or combined dietary changes modify the microbiota composition to prevent obesity. PMID:25791341

Monosodium L-Glutamate and Dietary Fat Differently Modify the Composition of the Intestinal Microbiota in Growing Pigs.

PubMed

Feng, Ze-Meng; Li, Tie-Jun; Wu, Li; Xiao, Ding-Fu; Blachier, Francois; Yin, Yu-Long

2015-01-01

The Chinese have been undergone rapid transition to a high-fat diet-consuming lifestyle, while monosodium L-glutamate (MSG) is widely used as a daily food additive. It has been reported that fat alters the composition of intestinal microbiota. However, little information is available on the effects of oral MSG on intestinal microbiota, and no study was done focusing on the interaction effect of fat and MSG with respect to intestinal microbiota. The present study thus aimed to determine the effects of MSG and/or fat on intestinal microbiota, and also to identify possible interactions between these two nutrients. Four iso-nitrogenous and iso-caloric diets were provided to growing pigs. The microbiota from jejunum, ileum, cecum, and colon were analyzed. Our results show that both MSG and fat clearly increased the intestinal microbiota diversity. MSG and fat modified the composition of intestinal microbiota, particularly in the colon. Both MSG and fat promoted the colonization of microbes related to energy extraction in gastrointestinal tract via different ways. MSG promoted the colonization of Faecalibacterium prausnitzii and Roseburia, while fat increased the percentage of Prevotella in colon and other intestinal segments. Our results will help to understand how individual or combined dietary changes modify the microbiota composition to prevent obesity.

Mex3a Marks a Slowly Dividing Subpopulation of Lgr5+ Intestinal Stem Cells.

PubMed

Barriga, Francisco M; Montagni, Elisa; Mana, Miyeko; Mendez-Lago, Maria; Hernando-Momblona, Xavier; Sevillano, Marta; Guillaumet-Adkins, Amy; Rodriguez-Esteban, Gustavo; Buczacki, Simon J A; Gut, Marta; Heyn, Holger; Winton, Douglas J; Yilmaz, Omer H; Attolini, Camille Stephan-Otto; Gut, Ivo; Batlle, Eduard

2017-06-01

Highly proliferative Lgr5+ stem cells maintain the intestinal epithelium and are thought to be largely homogeneous. Although quiescent intestinal stem cell (ISC) populations have been described, the identity and features of such a population remain controversial. Here we report unanticipated heterogeneity within the Lgr5+ ISC pool. We found that expression of the RNA-binding protein Mex3a labels a slowly cycling subpopulation of Lgr5+ ISCs that contribute to all intestinal lineages with distinct kinetics. Single-cell transcriptome profiling revealed that Lgr5+ cells adopt two discrete states, one of which is defined by a Mex3a expression program and relatively low levels of proliferation genes. During homeostasis, Mex3a+ cells continually shift into the rapidly dividing, self-renewing ISC pool. Chemotherapy and radiation preferentially target rapidly dividing Lgr5+ cells but spare the Mex3a-high/Lgr5+ population, helping to promote regeneration of the intestinal epithelium following toxic insults. Thus, Mex3a defines a reserve-like ISC population within the Lgr5+ compartment. Copyright © 2017 Elsevier Inc. All rights reserved.

Frequency of Dehiscence in Hand-Sutured and Stapled Intestinal Anastomoses in Dogs.

PubMed

Duell, Jason R; Thieman Mankin, Kelley M; Rochat, Mark C; Regier, Penny J; Singh, Ameet; Luther, Jill K; Mison, Michael B; Leeman, Jessica J; Budke, Christine M

2016-01-01

To determine the frequency of dehiscence of hand-sutured and stapled intestinal anastomoses in the dog and compare the surgery duration for the methods of anastomosis. Historical cohort study. Two hundred fourteen client-owned dogs undergoing hand-sutured (n = 142) or stapled (n = 72) intestinal anastomoses. Medical records from 5 referral institutions were searched for dogs undergoing intestinal resection and anastomosis between March 2006 and February 2014. Demographic data, presence of septic peritonitis before surgery, surgical technique (hand-sutured or stapled), surgery duration, surgeon (resident versus faculty member), indication for surgical intervention, anatomic location of resection and anastomosis, and if dehiscence was noted postoperatively were retrieved. Estimated frequencies were summarized and presented as proportions and 95% confidence intervals (CI) and continuous outcomes as mean (95% CI). Comparisons were made across methods of anastomosis. Overall, 29/205 dogs (0.14, 95% CI 0.10-00.19) had dehiscence, including 21/134 dogs (0.16, 0.11-0.23) undergoing hand-sutured anastomosis and 8/71 dogs (0.11, 0.06-0.21) undergoing stapled anastomosis. There was no significant difference in the frequency of dehiscence across anastomosis methods (χ(2), P = .389). The mean (95% CI) surgery duration of 140 minutes (132-147) for hand- sutured anastomoses and 108 minutes (99-119) for stapled anastomoses was significantly different (t-test, P < .001). No significant difference in frequency of dehiscence was noted between hand- sutured and stapled anastomoses in dogs but surgery duration is significantly reduced by the use of staples for intestinal closure. © Copyright 2015 by The American College of Veterinary Surgeons.

Ethical conflicts and moral distress experienced by paediatric residents during their training

PubMed Central

Hilliard, RI; Harrison, C; Madden, S

2007-01-01

significant ethical conflicts and moral distress. Understanding these ethical issues will help those responsible for postgraduate medical education to review or revise the ethics curriculum in keeping with the current moral distress experienced by residents, and help to mentor and guide trainees. PMID:19030336

Intestinal lymphangiectasia in adults.

PubMed

Freeman, Hugh James; Nimmo, Michael

2011-02-15

Intestinal lymphangiectasia in the adult may be characterized as a disorder with dilated intestinal lacteals causing loss of lymph into the lumen of the small intestine and resultant hypoproteinemia, hypogammaglobulinemia, hypoalbuminemia and reduced number of circulating lymphocytes or lymphopenia. Most often, intestinal lymphangiectasia has been recorded in children, often in neonates, usually with other congenital abnormalities but initial definition in adults including the elderly has become increasingly more common. Shared clinical features with the pediatric population such as bilateral lower limb edema, sometimes with lymphedema, pleural effusion and chylous ascites may occur but these reflect the severe end of the clinical spectrum. In some, diarrhea occurs with steatorrhea along with increased fecal loss of protein, reflected in increased fecal alpha-1-antitrypsin levels, while others may present with iron deficiency anemia, sometimes associated with occult small intestinal bleeding. Most lymphangiectasia in adults detected in recent years, however, appears to have few or no clinical features of malabsorption. Diagnosis remains dependent on endoscopic changes confirmed by small bowel biopsy showing histological evidence of intestinal lymphangiectasia. In some, video capsule endoscopy and enteroscopy have revealed more extensive changes along the length of the small intestine. A critical diagnostic element in adults with lymphangiectasia is the exclusion of entities (e.g. malignancies including lymphoma) that might lead to obstruction of the lymphatic system and "secondary" changes in the small bowel biopsy. In addition, occult infectious (e.g. Whipple's disease from Tropheryma whipplei) or inflammatory disorders (e.g. Crohn's disease) may also present with profound changes in intestinal permeability and protein-losing enteropathy that also require exclusion. Conversely, rare B-cell type lymphomas have also been described even decades following initial

Intestinal lymphangiectasia in adults

PubMed Central

Freeman, Hugh James; Nimmo, Michael

2011-01-01

Intestinal lymphangiectasia in the adult may be characterized as a disorder with dilated intestinal lacteals causing loss of lymph into the lumen of the small intestine and resultant hypoproteinemia, hypogammaglobulinemia, hypoalbuminemia and reduced number of circulating lymphocytes or lymphopenia. Most often, intestinal lymphangiectasia has been recorded in children, often in neonates, usually with other congenital abnormalities but initial definition in adults including the elderly has become increasingly more common. Shared clinical features with the pediatric population such as bilateral lower limb edema, sometimes with lymphedema, pleural effusion and chylous ascites may occur but these reflect the severe end of the clinical spectrum. In some, diarrhea occurs with steatorrhea along with increased fecal loss of protein, reflected in increased fecal alpha-1-antitrypsin levels, while others may present with iron deficiency anemia, sometimes associated with occult small intestinal bleeding. Most lymphangiectasia in adults detected in recent years, however, appears to have few or no clinical features of malabsorption. Diagnosis remains dependent on endoscopic changes confirmed by small bowel biopsy showing histological evidence of intestinal lymphangiectasia. In some, video capsule endoscopy and enteroscopy have revealed more extensive changes along the length of the small intestine. A critical diagnostic element in adults with lymphangiectasia is the exclusion of entities (e.g. malignancies including lymphoma) that might lead to obstruction of the lymphatic system and “secondary” changes in the small bowel biopsy. In addition, occult infectious (e.g. Whipple’s disease from Tropheryma whipplei) or inflammatory disorders (e.g. Crohn’s disease) may also present with profound changes in intestinal permeability and protein-losing enteropathy that also require exclusion. Conversely, rare B-cell type lymphomas have also been described even decades following

[Changes in the peritoneum of the small intestine and diaphragm in experimental portal hypertension].

PubMed

Khoroshaev, V A; Vorozheĭkin, V M; Baĭbekov, I M

1991-04-01

Diaphragm and small intestine peritoneum morphology was studied in experimental portal hypertension in rats with the help of luminescent, transmission and scanning electron microscopy techniques. Structural organizations of these peritoneum portions and performance function were different: fluid transudation realized through the small intestine peritoneum and resorption occurred via diaphragm peritoneum. Morphological signs allowed to judge about the increasing of fluid transudation in abdominal cavity and diaphragmatic resorption in early period of portal hypertension. Morphological alterations appeared in peritoneum resorption sites (pumping diaphragmatic hatchs) according to progress of portal hypertension that indicated decompensation process of peritoneal fluid absorption and led to ascites.

Effects of vasoactive intestinal peptide and pancreatic polypeptide in rabbit intestine.

PubMed Central

Camilleri, M; Cooper, B T; Adrian, T E; Bloom, S R; Chadwick, V S

1981-01-01

The effects of porcine vasoactive intestinal peptide (VIP) and bovine pancreatic polypeptide (PP) on jejunal, ileal, and colonic fluid transport were studied in the rabbit. VIP produced secretion in the small intestine (jejunum greater than ileum) but did not affect absorption in the colon. PP had no secretory effects in jejunum, ileum, or colon. The small intestinal secretion induced by VIP was not associated with raised cAMP concentrations in the mucosa; this suggests that the secretory effects of VIP in vivo are mediated by a mechanism other than stimulation of adenylate cyclase. PMID:6257593

Expression of an Intestine-Specific Transcription Factor (CDX1) in Intestinal Metaplasia and in Subsequently Developed Intestinal Type of Cholangiocarcinoma in Rat Liver

PubMed Central

Ren, Ping; Silberg, Debra G.; Sirica, Alphonse E.

2000-01-01

CDX1 is a caudal-type homeobox intestine-specific transcription factor that has been shown to be selectively expressed in epithelial cells in intestinal metaplasia of the human stomach and esophagus and variably expressed in human gastric and esophageal adenocarcinomas (Silberg DG, Furth EE, Taylor JK, Schuck T, Chiou T, Traber PG: Gastroenterology 1997, 113: 478–486). Through the use of immunohistochemistry and Western blotting, we investigated whether CDX1 is also uniquely associated with the intestinal metaplasia associated with putative precancerous cholangiofibrosis induced in rat liver during furan cholangiocarcinogenesis, as well as expressed in neoplastic glands in a subsequently developed intestinal type of cholangiocarcinoma. In normal, control adult rat small intestine, specific nuclear immunoreactivity for CDX1 was most prominent in enterocytes lining the crypts. In comparison, epithelium from intestinal metaplastic glands within furan-induced hepatic cholangiofibrosis and neoplastic epithelium from later developed primary intestinal-type cholangiocarcinoma each demonstrated strong nuclear immunoreactivity for CDX1. CDX1-positive cells were detected in hepatic cholangiofibrotic tissue as early as 3 weeks after the start of chronic furan treatment. We further determined that the percentages of CDX1-positive neoplastic glands and glandular nuclei are significantly higher in primary tumors than in a derived, transplantable cholangiocarcinoma serially-propagated in vivo. Western blotting confirmed our immunohistochemical results, and no CDX1 immunoreactivity was detected in normal adult rat liver or in hyperplastic biliary epithelial cells. These findings indicate that CDX1 is specifically associated with early intestinal metaplasia and a later developed intestinal-type of cholangiocarcinoma induced in the liver of furan-treated rats. PMID:10666391

An Ecological Network of Polysaccharide Utilization Among Human Intestinal Symbionts

PubMed Central

Rakoff-Nahoum, Seth; Coyne, Michael J.; Comstock, Laurie E.

2013-01-01

Summary Background: The human intestine is colonized with trillions of microorganisms important to health and disease. There has been an intensive effort to catalog the species and genetic content of this microbial ecosystem. However, little is known of the ecological interactions between these microbes, a prerequisite to understanding the dynamics and stability of this host-associated microbial community. Here we perform a systematic investigation of public goods-based syntrophic interactions among the abundant human gut bacteria, the Bacteroidales. Results: We find evidence for a rich interaction network based on the breakdown and use of polysaccharides. Species that utilize a particular polysaccharide (producers) liberate polysaccharide breakdown products (PBP) that are consumed by other species unable to grow on the polysaccharide alone (recipients). Cross-species gene addition experiments demonstrate that recipients can grow on a polysaccharide if the producer-derived glycoside hydrolase, responsible for PBP generation, is provided. These producer-derived glycoside hydrolases are public goods transported extracellularly in outer membrane vesicles allowing for the creation of PBP and concomitant recipient growth spatially distant from the producer. Recipients can exploit these ecological interactions and conditionally outgrow producers. Finally, we show that these public good-based interactions occur among Bacteroidales species co-resident within a natural human intestinal community. Conclusions: This study examines public-goods based syntrophic interactions between bacterial members of the critically important gut microbial ecosystem. This polysaccharide-based network likely represents foundational relationships creating organized ecological units within the intestinal microbiota, knowledge of which can be applied to impact human health. PMID:24332541

A microengineered collagen scaffold for generating a polarized crypt-villus architecture of human small intestinal epithelium.

PubMed

Wang, Yuli; Gunasekara, Dulan B; Reed, Mark I; DiSalvo, Matthew; Bultman, Scott J; Sims, Christopher E; Magness, Scott T; Allbritton, Nancy L

2017-06-01

The human small intestinal epithelium possesses a distinct crypt-villus architecture and tissue polarity in which proliferative cells reside inside crypts while differentiated cells are localized to the villi. Indirect evidence has shown that the processes of differentiation and migration are driven in part by biochemical gradients of factors that specify the polarity of these cellular compartments; however, direct evidence for gradient-driven patterning of this in vivo architecture has been hampered by limitations of the in vitro systems available. Enteroid cultures are a powerful in vitro system; nevertheless, these spheroidal structures fail to replicate the architecture and lineage compartmentalization found in vivo, and are not easily subjected to gradients of growth factors. In the current work, we report the development of a micropatterned collagen scaffold with suitable extracellular matrix and stiffness to generate an in vitro self-renewing human small intestinal epithelium that replicates key features of the in vivo small intestine: a crypt-villus architecture with appropriate cell-lineage compartmentalization and an open and accessible luminal surface. Chemical gradients applied to the crypt-villus axis promoted the creation of a stem/progenitor-cell zone and supported cell migration along the crypt-villus axis. This new approach combining microengineered scaffolds, biophysical cues and chemical gradients to control the intestinal epithelium ex vivo can serve as a physiologically relevant mimic of the human small intestinal epithelium, and is broadly applicable to model other tissues that rely on gradients for physiological function. Copyright © 2017 Elsevier Ltd. All rights reserved.

The Effect of DA-6034 on Intestinal Permeability in an Indomethacin-Induced Small Intestinal Injury Model.

PubMed

Kwak, Dong Shin; Lee, Oh Young; Lee, Kang Nyeong; Jun, Dae Won; Lee, Hang Lak; Yoon, Byung Chul; Choi, Ho Soon

2016-05-23

DA-6034 has anti-inflammatory activities and exhibits cytoprotective effects in acute gastric injury models. However, explanations for the protective effects of DA-6034 on intestinal permeability are limited. This study sought to investigate the effect of DA-6034 on intestinal permeability in an indomethacin-induced small intestinal injury model and its protective effect against small intestinal injury. Rats in the treatment group received DA-6034 from days 0 to 2 and indomethacin from days 1 to 2. Rats in the control group received indomethacin from days 1 to 2. On the fourth day, the small intestines were examined to compare the severity of inflammation. Intestinal permeability was evaluated by using fluorescein isothiocyanate-labeled dextran. Western blotting was performed to confirm the association between DA-6034 and the extracellular signal-regulated kinase (ERK) pathway. The inflammation scores in the treatment group were lower than those in the control group, but the difference was statistically insignificant. Hemorrhagic lesions in the treatment group were broader than those in the control group, but the difference was statistically insignificant. Intestinal permeability was lower in the treatment group than in the control group. DA-6034 enhanced extracellular signal-regulated kinase expression, and intestinal permeability was negatively correlated with ERK expression. DA-6034 may decrease intestinal permeability in an indomethacin-induced intestinal injury model via the ERK pathway.

Diet-Induced Dysbiosis of the Intestinal Microbiota and the Effects on Immunity and Disease

PubMed Central

Brown, Kirsty; DeCoffe, Daniella; Molcan, Erin; Gibson, Deanna L.

2012-01-01

The gastrointestinal (GI) microbiota is the collection of microbes which reside in the GI tract and represents the largest source of non-self antigens in the human body. The GI tract functions as a major immunological organ as it must maintain tolerance to commensal and dietary antigens while remaining responsive to pathogenic stimuli. If this balance is disrupted, inappropriate inflammatory processes can result, leading to host cell damage and/or autoimmunity. Evidence suggests that the composition of the intestinal microbiota can influence susceptibility to chronic disease of the intestinal tract including ulcerative colitis, Crohn’s disease, celiac disease and irritable bowel syndrome, as well as more systemic diseases such as obesity, type 1 diabetes and type 2 diabetes. Interestingly, a considerable shift in diet has coincided with increased incidence of many of these inflammatory diseases. It was originally believed that the composition of the intestinal microbiota was relatively stable from early childhood; however, recent evidence suggests that diet can cause dysbiosis, an alteration in the composition of the microbiota, which could lead to aberrant immune responses. The role of the microbiota and the potential for diet-induced dysbiosis in inflammatory conditions of the GI tract and systemic diseases will be discussed. PMID:23016134

Efficacy and acceptance of professional dental cleaning among nursing home residents.

PubMed

Barbe, Anna Greta; Kottmann, Hannah Elisa; Hamacher, Stefanie; Derman, Sonja Henny Maria; Noack, Michael Johannes

2018-05-13

To determine the impact of general and oral health status of nursing home residents in Germany on efficacy and acceptance of professional dental cleaning performed by a dental nurse. Participants (N = 41; mean age 83 ± 8 years) living in a nursing home were included. Personal and general health, oral health, oral hygiene habits, and needs were investigated. Individual acceptance regarding professional dental cleaning via different devices (scaler, interdental brushes, ultrasonic cleaning) was assessed, as was the efficacy of this method using after-cleaning indices. Oral health among nursing home residents was impaired and independent from dementia status. Most residents (33/41) performed oral hygiene procedures independently and showed better index values than those in need of external help. Residents requiring help with oral hygiene showed increased risk profiles (higher age, more often immobile, demented, more xerostomia). The dental cleaning procedure required a mean time of 37 ± 11 min, was widely accepted (36/41), and achieved clean results (plaque index 0.1 ± 0.5, oral hygiene index 0.2 ± 1.6, Volpe-Manhold index 0.4 ± 1.6); food residues were reduced to 0 independent from cognitive status. Regarding the cleaning methods, scalers were accepted best without difference between demented and non-demented residents. Professional dental cleaning in nursing homes is an accepted and efficacious oral hygiene procedure among nursing home residents. Professional dental cleaning is an efficacious and accepted method as a first step in line with strategies to improve oral health and should be considered in nursing home residents.

Teaching Humanities in Medicine: The University of Massachusetts Family Medicine Residency Program Experience

ERIC Educational Resources Information Center

Silk, Hugh; Shields, Sara

2012-01-01

Humanities in medicine (HIM) is an important aspect of medical education intended to help preserve humanism and a focus on patients. At the University of Massachusetts Family Medicine Residency Program, we have been expanding our HIM curriculum for our residents including orientation, home visit reflective writing, didactics and a department-wide…

Lipid rafts are disrupted in mildly inflamed intestinal microenvironments without overt disruption of the epithelial barrier.

PubMed

Bowie, Rachel V; Donatello, Simona; Lyes, Clíona; Owens, Mark B; Babina, Irina S; Hudson, Lance; Walsh, Shaun V; O'Donoghue, Diarmuid P; Amu, Sylvie; Barry, Sean P; Fallon, Padraic G; Hopkins, Ann M

2012-04-15

Intestinal epithelial barrier disruption is a feature of inflammatory bowel disease (IBD), but whether barrier disruption precedes or merely accompanies inflammation remains controversial. Tight junction (TJ) adhesion complexes control epithelial barrier integrity. Since some TJ proteins reside in cholesterol-enriched regions of the cell membrane termed lipid rafts, we sought to elucidate the relationship between rafts and intestinal epithelial barrier function. Lipid rafts were isolated from Caco-2 intestinal epithelial cells primed with the proinflammatory cytokine interferon-γ (IFN-γ) or treated with methyl-β-cyclodextrin as a positive control for raft disruption. Rafts were also isolated from the ilea of mice in which colitis had been induced in conjunction with in vivo intestinal permeability measurements, and lastly from intestinal biopsies of ulcerative colitis (UC) patients with predominantly mild or quiescent disease. Raft distribution was analyzed by measuring activity of the raft-associated enzyme alkaline phosphatase and by performing Western blot analysis for flotillin-1. Epithelial barrier integrity was estimated by measuring transepithelial resistance in cytokine-treated cells or in vivo permeability to fluorescent dextran in colitic mice. Raft and nonraft fractions were analyzed by Western blotting for the TJ proteins occludin and zonula occludens-1 (ZO-1). Our results revealed that lipid rafts were disrupted in IFN-γ-treated cells, in the ilea of mice with subclinical colitis, and in UC patients with quiescent inflammation. This was not associated with a clear pattern of occludin or ZO-1 relocalization from raft to nonraft fractions. Significantly, a time-course study in colitic mice revealed that disruption of lipid rafts preceded the onset of increased intestinal permeability. Our data suggest for the first time that lipid raft disruption occurs early in the inflammatory cascade in murine and human colitis and, we speculate, may contribute to

Perceptions, training experiences, and preferences of surgical residents toward laparoscopic simulation training: a resident survey.

PubMed

Shetty, Shohan; Zevin, Boris; Grantcharov, Teodor P; Roberts, Kurt E; Duffy, Andrew J

2014-01-01

Simulation training for surgical residents can shorten learning curves, improve technical skills, and expedite competency. Several studies have shown that skills learned in the simulated environment are transferable to the operating room. Residency programs are trying to incorporate simulation into the resident training curriculum to supplement the hands-on experience gained in the operating room. Despite the availability and proven utility of surgical simulators and simulation laboratories, they are still widely underutilized by surgical trainees. Studies have shown that voluntary use leads to minimal participation in a training curriculum. Although there are several simulation tools, there is no clear evidence of the superiority of one tool over the other in skill acquisition. The purpose of this study was to explore resident perceptions, training experiences, and preferences regarding laparoscopic simulation training. Our goal was to profile resident participation in surgical skills simulation, recognize potential barriers to voluntary simulator use, and identify simulation tools and tasks preferred by residents. Furthermore, this study may help to inform whether mandatory/protected training time, as part of the residents' curriculum is essential to enhance participation in the simulation laboratory. A cross-sectional study on general surgery residents (postgraduate years 1-5) at Yale University School of Medicine and the University of Toronto via an online questionnaire was conducted. Overall, 67 residents completed the survey. The institutional review board approved the methods of the study. Overall, 95.5% of the participants believed that simulation training improved their laparoscopic skills. Most respondents (92.5%) perceived that skills learned during simulation training were transferrable to the operating room. Overall, 56.7% of participants agreed that proficiency in a simulation curriculum should be mandatory before operating room experience. The

Multifunctional Bioreactor System for Human Intestine Tissues

PubMed Central

2017-01-01

The three-dimensional (3D) cultivation of intestinal cells and tissues in dynamic bioreactor systems to represent in vivo intestinal microenvironments is essential for developing regenerative medicine treatments for intestinal diseases. We have previously developed in vitro human intestinal tissue systems using a 3D porous silk scaffold system with intestinal architectures and topographical features for the adhesion, growth, and differentiation of intestinal cells under static culture conditions. In this study, we designed and fabricated a multifunctional bioreactor system that incorporates pre-epithelialized 3D silk scaffolds in a dynamic culture environment for in vitro engineering of human intestine tissues. The bioreactor system allows for control of oxygen levels in perfusion fluids (aerobic simulated intestinal fluid (SIF), microaerobic SIF, and anaerobic SIF), while ensuring control over the mechanical and chemical microenvironments present in native human intestines. The bioreactor system also enables 3D cell culture with spatial separation and cultivation of cocultured epithelial and stromal cells. Preliminary functional analysis of tissues housed in the bioreactor demonstrated that the 3D tissue constructs survived and maintained typical phenotypes of intestinal epithelium, including epithelial tight junction formation, intestinal biomarker expression, microvilli formation, and mucus secretion. The unique combination of a dynamic bioreactor and 3D intestinal constructs offers utility for engineering human intestinal tissues for the study of intestinal diseases and discovery options for new treatments. PMID:29333491

Microanatomy of the intestinal lymphatic system

PubMed Central

Miller, Mark J.; Newberry, Rodney D.

2011-01-01

The intestinal lymphatic system is comprised of two non-communicating lymphatic networks; one containing the lacteals draining the villi and the connecting submucosal lymphatic network, and one containing the lymphatics that drain the intestine muscular layer. These systems deliver lymph into a common network of collecting lymphatics originating near the mesenteric border. The intestinal lymphatic system serves vital functions in the regulation of tissue fluid homeostasis, immune surveillance, and the transport of nutrients, and conversely this system is affected by, and directly contributes to, disease processes within the intestine. Recent discoveries of specific lymphatic markers, factors promoting lymphangiogenesis, and factors selectively affecting the development of intestinal lymphatics hold promise for unlocking the role of lymphatics in the pathogenesis of diseases affecting the intestine and for intestinal lymphatic selective therapies. Vital to progress in understanding how the intestinal lymphatic system functions is integrating of recent advances identifying molecular pathways for lymphatic growth and remodeling with advanced imaging modalities to observe lymphatic function and dysfunction in vivo. PMID:20961303

Intestinal Microbiota Signatures Associated With Histological Liver Steatosis in Pediatric-Onset Intestinal Failure.

PubMed

Korpela, Katri; Mutanen, Annika; Salonen, Anne; Savilahti, Erkki; de Vos, Willem M; Pakarinen, Mikko P

2017-02-01

Intestinal failure (IF)-associated liver disease (IFALD) is the major cause of mortality in IF. The link between intestinal microbiota and IFALD is unclear. We compared intestinal microbiota of patients with IF (n = 23) with healthy controls (n = 58) using culture-independent phylogenetic microarray analysis. The microbiota was related to histological liver injury, fecal markers of intestinal inflammation, matrix metalloproteinase 9 and calprotectin, and disease characteristics. Overabundance of Lactobacilli, Proteobacteria, and Actinobacteria was observed in IF, whereas bacteria related to Clostridium clusters III, IV, and XIVa along with overall diversity and richness were reduced. Patients were segregated into 3 subgroups based on dominating bacteria: Clostridium cluster XIVa, Proteobacteria, and bacteria related to Lactobacillus plantarum. In addition to liver steatosis and fibrosis, Proteobacteria were associated with prolonged current parenteral nutrition (PN) as well as liver and intestinal inflammation. Lactobacilli were related to advanced steatosis and fibrosis mostly after weaning off PN without associated inflammation. In multivariate permutational analysis of variance, liver steatosis, bowel length, PN calories, and antibiotic treatment best explained the microbiota variation among patients with IF. Intestinal microbiota composition was associated with liver steatosis in IF and better predicted steatosis than duration of PN or length of the remaining intestine. Our results may be explained by a model in which steatosis is initiated during PN in response to proinflammatory lipopolysaccharides produced by Proteobacteria and progresses after weaning off PN, as the L plantarum group Lactobacilli becomes dominant and affects lipid metabolism by altering bile acid signaling.

Primary intestinal lymphangiectasia.

PubMed

Suresh, N; Ganesh, R; Sankar, Janani; Sathiyasekaran, Malathi

2009-10-01

Primary intestinal lymphangiectasia (PIL) is a rare disease of intestinal lymphatics presenting with hypoproteinemia, bilateral lower limb edema, ascites, and protein losing enteropathy. We report a series of 4 children from Chennai, India presenting with anasarca, recurrent diarrhea, hypoproteinemia and confirmatory features of PIL on endoscopy and histopathology.

Maternity leave: existing policies in obstetrics and gynecology residency programs.

PubMed

Davis, J L; Baillie, S; Hodgson, C S; Vontver, L; Platt, L D

2001-12-01

To survey program directors in obstetrics and gynecology regarding maternity leave and to determine how programs are dealing with maternity leave coverage. Questionnaires regarding impact and policy on maternity leave were mailed to accredited obstetrics and gynecology residency programs. A total of 188 of 274 (69%) questionnaires were returned completed. Respectively, 80% and 69% of respondents indicated that they have a formal maternity (maximum mean 8.7 weeks) and paternity (mean 5.27 days) leave policy. Approximately 75% of programs require residents to make up time if their leave exceeds 8 weeks during the first 3 years. Eighty-five percent of programs require residents to make up time if their leave exceeds 6 weeks during the fourth year. Ninety-three percent of programs require residents to make up time if their leave exceeds 20 weeks over the 4 years. Seventy-seven percent of respondents have other residents in their program cover for the absent resident. Thirty-seven percent of programs have schedules flexible enough to allow rearrangement so that some rotations go uncovered. Eighty-three percent of programs surveyed stated that maternity leave has a somewhat to very significant impact on the residents' schedules. Most residency programs have written maternity/paternity leave policies. A more flexible curriculum may help to accommodate the residents on leave without overburdening the residents who are left to cover.

Serum cholesterol: attitudes and behavior of family practice residents.

PubMed

Kelly, R B; Velez-Holvino, O; Alemagno, S A

1991-09-01

Given the current health promotion efforts regarding coronary artery disease, more information is needed about residents' attitudes and behaviors that relate to identification and management of patients with elevated serum cholesterol levels. Family practice residents from eight US programs (N = 128) were surveyed in 1989 to assess their attitudes and reported practice patterns. Resident survey data were compared, when feasible, to published data from 1986 and 1990 surveys of practicing physicians performed by the National Heart, Lung, and Blood Institute. The use of faculty "key contacts" resulted in a 90% response rate (N = 115). Both residents and practicing physicians attributed a high degree of importance to cholesterol as a risk factor. Residents reported more frequent routine screening of middle-aged men than the routine screening rate of practicing physicians in 1986 (P less than .01). Residents reported less frequent screening of younger and older adults than of middle-aged men (P less than .001). Residents' threshold for the use of cholesterol-lowering medication was lower than that of practicing physicians surveyed in 1986, but higher than that of physicians surveyed in 1990. Compared with practicing physicians, residents did not believe they were as well prepared to counsel patients about dietary change or as successful when they tried to help patients make changes; residents reported a significantly higher rate of referral to dietitians (P less than .01). Residents may need more education regarding screening guidelines for children and young adults. A health promotion skills gap may exist that explains reported discrepancies between self-report and actual behavior and indicates that residency educators may need to pay more attention to fostering dietary assessment and counseling skills in their residents.

The Intestinal Microbiome and Health

PubMed Central

Tuddenham, Susan; Sears, Cynthia L.

2015-01-01

Purpose of Review A diverse array of microbes colonizes the human intestine. In this review we seek to outline the current state of knowledge on what characterizes a “healthy” or “normal” intestinal microbiome, what factors modify the intestinal microbiome in the healthy state and how the intestinal microbiome affects normal host physiology Recent Findings What constitutes a “normal” or “healthy” intestinal microbiome is an area of active research, but key characteristics may include diversity, richness and a microbial community’s resilience and ability to resist change. A number of factors, including age, the host immune system, host genetics, diet and antibiotic use appear to modify the intestinal microbiome in the normal state. New research shows that the microbiome likely plays a critical role in the healthy human immune system and metabolism. Summary It is clear that there is a complicated bi-directional relationship between the intestinal microbiota and host which is vital to health. An enhanced understanding of this relationship will be critical not only to maximize and maintain human health but also to shape our understanding of disease and to foster new therapeutic approaches. PMID:26237547

An Analysis of Research Quality and Productivity at Six Academic Orthopaedic Residencies.

PubMed

Osborn, Patrick M; Ames, S Elizabeth; Turner, Norman S; Caird, Michelle S; Karam, Matthew D; Mormino, Matthew A; Krueger, Chad A

2018-06-06

It remains largely unknown what factors impact the research productivity of residency programs. We hypothesized that dedicated resident research time would not affect the quantity and quality of a program's peer-reviewed publication within orthopedic residencies. These findings may help programs improve structure their residency programs to maximize core competencies. Three hundred fifty-nine residents and 240 staff from six different US orthopedic residency programs were analyzed. All publications published by residents and faculty at each program from January 2007 to December 2015 were recorded. SCImago Journal Rankings (SJR) were found for each journal. There were no significant differences in publications by residents at each program (p > 0.05). Faculty with 10+ years of on staff, had significantly more publications than those with less than 10years (p < 0.01). Programs with increased resident research time did not consistently produce publications with higher SJR than those without dedicated research time. Increased dedicated resident research time did not increase resident publication rates or lead to publications with higher SJR. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Description of a medical writing rotation for a postgraduate pharmacy residency program.

PubMed

Brown, Jamie N; Tiemann, Kelsey A; Ostroff, Jared L

2014-04-01

To provide a description of a pharmacy residency rotation dedicated to medical writing developed at a tertiary care academic medical center. Contribution to the medical literature is an important component of professional pharmacy practice, and there are many benefits seen by practitioners actively involved in scholarly activities. Residency programs have an opportunity to expand beyond the standard roles of postgraduate pharmacist training but rarely is there formal instruction on medical writing skills or are scholarship opportunities provided to residents. In order to address this deficiency, a residency program may consider the implementation of a formal Medical Writing rotation. This rotation is designed to introduce the resident to medical writing through active discussion on medical writing foundational topics, engage the resident in a collaborative review of a manuscript submitted to a peer-reviewed professional journal, and support the resident in the design and composition of manuscript of publishable quality. A structured Medical Writing rotation during a pharmacy resident's training can help develop the skills necessary to promote scholarly activities and foster resident interest in future pursuit of professional medical writing.

Facilitators and barriers to self-management of nursing home residents: perspectives of health-care professionals in Korean nursing homes.

PubMed

Park, Yeon-Hwan; Bang, Hwal Lan; Kim, Ga Hye; Ha, Ji Yeon

2015-01-01

To explore facilitators and barriers to self-management from the viewpoint of staff taking care of nursing home (NH) residents with chronic diseases in South Korea. A qualitative content analysis was done using the focus group interview method. A total of 23 health-care professionals (16 registered nurses and 7 social workers) were interviewed from three urban NHs, each with more than 100 beds. Five facilitators were identified: grouping the residents; the resident's awareness of his/her current health status; the willingness of residents to engage in self-management; residence in the facility; and support from the staff. Additionally, seven barriers were identified: deterioration of the resident's health; the dependency expectations of the resident; hesitation in asking for help; difference in expectations between the staff and the resident's family; insufficient staffing and time; lack of standardized guidelines; and conservative tendencies of the staff due to rigid policies. The findings of this study can help health-care professionals recognize the factors that influence self-management and provide direction for registered nurses and other health professionals involved in supporting self-management programs for NH residents.

Quality Improvement in Skilled Nursing Facilities for Residents With Alzheimer's Disease.

PubMed

Farlow, Martin R; Borson, Soo; Connor, Stephen R; Grossberg, George T; Mittelman, Mary S

2016-03-01

This report describes a quality improvement continuing medical education activity designed to enhance the recognition and treatment of residents with Alzheimer's disease (AD) or other dementias in skilled-nursing facilities (SNFs). Charts were compared in 6 areas prior to and following (stages A and C) a live, faculty-led workshop (stage B). Four SNFs completed stages A (n = 67 residents) and B, and 3 SNFs completed stage C (n = 52 residents). All charts came from residents with AD or a diagnosis of dementia or dementia-like symptoms. The SNFs had >95% baseline performance in both the frequency of cognitive assessments and documented medication reviews. The percentage of residents who received a quality-of-life assessment and those who had a mental health care plan in place represent areas for improvement. As part of this activity, a toolkit was developed to help guide facilities and clinicians in instituting care improvements for residents with AD/dementia. © The Author(s) 2015.

Preinduced intestinal HSP70 improves visceral hypersensitivity and abnormal intestinal motility in PI-IBS mouse model.

PubMed

Lan, Cheng; Sun, Xiao-Ning; Zhou, Xu-Chun; Yang, Bo; Huang, Bai-Li; Deng, Tao-Zhi; He, Zhou-Tao; Han, Xiang-Yang

2016-03-01

To investigate the impact of the preinduced intestinal heat shock protein 70 (HSP70) on the visceral hypersensitivity and abnormal intestinal motility in a post-infectious irritable bowel syndrome (PI-IBS) mouse model. Eighty-four female C57BL/6 mice were randomly assigned to four groups: control group (n = 21) and induction + PI-IBS group (n = 21), PI-IBS group (n = 21) and induction group (n = 21). The mice in PI-IBS group were infected in vivo with Trichinella spiralis by oral administration. The visceral hypersensitivity and intestinal motility were evaluated respectively with abdominal withdrawal reflex and colon transportation test. The intestinal HSP70 protein and mRNA level was measured by Western blot and real-time PCR. Meanwhile, the intestinal proinflammatory cytokines IL-10 and TNF-α level was detected by ELISA. Compared with their counterparts in PI-IBS group, the animals in the Induction + PI-IBS group show significantly increased intestinal level of HSP70 and obviously ameliorative clinical figures, including abdominal withdrawal reflex score, intestine transportation time and Bristol scores (P < 0.05). Meanwhile, the intestinal post-inflammatory cytokines remarkably changed, including increased IL-10 level and decreased TNF-α level (P < 0.05). Intestinal HSP70 may play a potential protective role through improving the imbalance between the intestinal post-inflammatory and anti-inflammatory cytokines in PI-IBS. Copyright © 2016 Hainan Medical College. Production and hosting by Elsevier B.V. All rights reserved.

Teaching immigrant and refugee health to residents: domestic global health.

PubMed

Asgary, Ramin; Smith, Clyde Lanford; Sckell, Blanca; Paccione, Gerald

2013-01-01

Half a million immigrants enter the United States annually. Clinical providers generally lack training in immigrant health. We developed a curriculum with didactic, clinical, and analytic components to advance residents' skills in immigrant and travel health. The curriculum focused on patients and their countries of origin and encompassed (a) societal, cultural, economical, and human rights profiles; (b) health system/ policies/resources/statistics, and environmental health; and (c) clinical manifestations, tropical and travel health. Residents evaluated sociocultural health beliefs and human rights abuses; performed history and physical examinations while precepted by faculty; developed specific care plans; and discussed patients in a dedicated immigrant health morning report. We assessed resident satisfaction using questionnaires and focus groups. Residents (n=20) found clinical, sociocultural, and epidemiological components the most helpful. Morning reports reinforced peer education. The immigrant health curriculum was useful for residents. Multiple teaching modules, collaboration with grassroot organizations, and an ongoing clinical component were key features.

The Effects of Abortion Training on Family Medicine Residents' Clinical Experience.

PubMed

Summit, Aleza K; Gold, Marji

2017-01-01

RHEDI, Reproductive Health Education in Family Medicine, offers technical assistance and funding to family medicine residency programs to support integrated opt-out abortion and reproductive health training for residents. This study assessed the impact of this enhanced training on residents' reproductive health experience. Investigator-developed pre- and post-surveys were administered online to 214 residents at 12 family medicine residency programs before and after their RHEDI training experience. Surveys addressed experience in contraception and abortion, attitudes around abortion provision, and post-residency intentions. Descriptive statistics were generated, and statistical tests were performed to assess changes after training. Surveys had a 90% response rate. After the RHEDI enhanced reproductive health rotation, residents reported increased experience in contraception provision, early pregnancy ultrasound, aspiration and medication abortion, and miscarriage management. After training, residents with experience in IUD insertion increased from 85% to 99%, and contraceptive implant insertion experience rose from 60% to 85%. Residents who had performed any abortions increased from 15% to 79%, and self-rated competency in abortion increased. Finally, almost all residents agreed that early abortion was within the scope of family medicine, and training confirmed residents' intentions to provide reproductive health services after residency. Integrated training in reproductive health, with an emphasis on abortion, increases residents' experience and underscores their understanding of the role of these services in family medicine. Increasing the number of family medicine residency programs that offer this training could help prepare family physicians to meet their patients' needs for reproductive health services.

Interdisciplinary curriculum to train internal medicine and obstetrics-gynecology residents in ambulatory women's health: adapting problem-based learning to residency education.

PubMed

Spencer, Abby L; McNeil, Melissa

2009-09-01

Although residents in internal medicine (IM) and obstetrics-gynecology (OG) must provide primary care for women, studies indicate that both groups require more skills and training in women's health. Our goals were to assess the needs of residents at our academic medical center and to design an interdisciplinary curriculum that addresses these needs utilizing a modified problem-based learning (PBL) format. The aim of this article is to report on the development, logistics, and successful implementation of our innovative curriculum. Based on results from a targeted needs-assessment, we designed a curriculum for both IM and OG residents to address curricular deficiencies in an efficient and effective manner. Procurement of support was achieved by reviewing overlapping competency requirements and results of the needs-assessment with the program directors. The curriculum consists of six ambulatory clinical cases which lead residents through a discussion of screening, diagnosis, prevention, and management within a modified PBL format. Residents select one learning objective each week which allows them to serve as content experts during case discussions, applying what they learned from their literature review to guide the group as they decide upon the next step for the case. This format helps accommodate different experience levels of learners, encourages discussion from less-vocal residents, and utilizes theories of adult learning. Sixty-five residents have participated in the curriculum since it was successfully implemented. IM residents report that the cases were their first opportunity to discuss the health concerns of younger women; OG residents felt similarly about cases related to older women. Implementation challenges included resident accountability. Residents identified the timing of the sessions and clinical coverage requirements as barriers to conference attendance. Interdisciplinary modified PBL conferences focusing on shared curricular needs in ambulatory

Intestinal radiation syndrome: sepsis and endotoxin

DOE Office of Scientific and Technical Information (OSTI.GOV)

Geraci, J.P.; Jackson, K.L.; Mariano, M.S.

Rats were whole-body irradiated with 8-MeV cyclotron-produced neutrons and /sup 137/Cs ..gamma.. rays to study the role of enteric bacteria and endotoxin in the intestinal radiation syndrome. Decrease in intestinal weight was used as an index of radiation-induced breakdown of the mucosa. Neutron and ..gamma..-ray doses that were sublethal for intestinal death resulted in a dose-dependent decrease in intestinal weight, reaching minimal values 2 to 3 days after exposure, followed by recovery within 5 days after irradiation. Neutron and photon doses that caused intestinal death resulted in greater mucosal breakdown with little or no evidence of mucosal recovery. The presencemore » of fluid in the intestine and diarrhea, but not bacteremia or endotoxemia, were related to mucosal breakdown and recovery. Neither sepsis nor endotoxin could be detected in liver samples taken at autopsy from animals which died a short time earlier from intestinal injury. These results suggest that overt sepsis and endotoxemia do not play a significant role in the intestinal radiation syndrome.« less

Hericium erinaceus polysaccharide facilitates restoration of injured intestinal mucosal immunity in Muscovy duck reovirus-infected Muscovy ducklings.

PubMed

Wu, Yijian; Jiang, Huihui; Zhu, Erpeng; Li, Jian; Wang, Quanxi; Zhou, Wuduo; Qin, Tao; Wu, Xiaoping; Wu, Baocheng; Huang, Yifan

2018-02-01

To elucidate the effect of Hericium erinaceus polysaccharide (HEP) on the intestinal mucosal immunity in normal and Muscovy duck reovirus (MDRV)-infected Muscovy ducklings, 1-day-old healthy Muscovy ducklings were pretreated with 0.2g/L HEP and/or following by MDRV infection in this study, duodenal samples were respectively collected at 1, 3, 6, 10, 15 and 21day post-infection, tissue sections were prepared for observation of morphological structure and determination of intestinal parameters (villus height/crypt depth ratio, villus surface area) as well as counts of intraepithelial lymphocytes (IELs), goblet cells, mast cells. Additionally, dynamics of secretory immunoglobin A (sIgA), interferon-γ (IFN-γ) and interleukin-4 (IL-4) productions in intestinal mucosa were measured with radioimmunoassay. Results showed that HEP significantly improved intestinal morphological structure and related indexes, and significantly inhibited the reduction of intestinal mucosal IELs, goblet cells and mast cells caused by MDRV infection. Furthermore, HEP significantly increased the secretion of sIgA, IFN-γ and IL-4 to enhance intestinal mucosal immune functions. Our findings indicate that HEP treatment can effectively repair MDRV-caused injures of small intestinal mucosal immune barrier, and improve mucosal immune function in sick Muscovy ducklings, which will provide valuable help for further application of HEP in prevention and treatment of MDRV infection. Copyright © 2017. Published by Elsevier B.V.

Characteristics of research tracks in dermatology residency programs: a national survey.

PubMed

Narala, Saisindhu; Loh, Tiffany; Shinkai, Kanade; Paravar, Taraneh

2017-12-15

Pursuing research is encouraged in dermatology residency programs. Some programs offer specific research or investigative tracks. Currently, there is little data on the structure or scope of research tracks in dermatology residency programs. An anonymous online survey was distributed to the Association of Professors of Dermatology listserve in 2016. Program directors of dermatology residency programs in the United States were asked to participate and 38 of the 95 program directors responded. The survey results confirmed that a 2+2 research track, which is two years of clinical training followed by two years of research, was the most common investigator trackmodel and may promote an academic career at the resident's home institution. Further studies will help determine the most effective research track models to promote long-term outcomes.

A single-cell survey of the small intestinal epithelium

PubMed Central

Haber, Adam L.; Biton, Moshe; Rogel, Noga; Herbst, Rebecca H.; Shekhar, Karthik; Smillie, Christopher; Burgin, Grace; Delorey, Toni M.; Howitt, Michael R.; Katz, Yarden; Tirosh, Itay; Beyaz, Semir; Dionne, Danielle; Zhang, Mei; Raychowdhury, Raktima; Garrett, Wendy S.; Rozenblatt-Rosen, Orit; Shi, Hai Ning; Yilmaz, Omer; Xavier, Ramnik J.; Regev, Aviv

2018-01-01

Intestinal epithelial cells (IECs) absorb nutrients, respond to microbes, provide barrier function and help coordinate immune responses. We profiled 53,193 individual epithelial cells from mouse small intestine and organoids, and characterized novel subtypes and their gene signatures. We showed unexpected diversity of hormone-secreting enteroendocrine cells and constructed their novel taxonomy. We distinguished between two tuft cell subtypes, one of which expresses the epithelial cytokine TSLP and CD45 (Ptprc), the pan-immune marker not previously associated with non-hematopoietic cells. We also characterized how cell-intrinsic states and cell proportions respond to bacterial and helminth infections. Salmonella infection caused an increase in Paneth cells and enterocytes abundance, and broad activation of an antimicrobial program. In contrast, Heligmosomoides polygyrus caused an expansion of goblet and tuft cell populations. Our survey highlights new markers and programs, associates sensory molecules to cell types, and uncovers principles of gut homeostasis and response to pathogens. PMID:29144463

Preparing Secondary Stem Teachers for High-Need Schools: Challenges of an Urban Residency Program

ERIC Educational Resources Information Center

Garza, Rubén; Duchaine, Ellen L.; Reynosa, Raymond

2013-01-01

Teaching residency programs that blend coursework with clinical experiences have emerged nationwide to prepare aspiring teachers for the demanding reality of teaching in high-need urban schools. The Teaching Residency Program for Critical Shortage Areas was created to help urban school districts with the challenge of recruiting and retaining…

The "Near-Peer" Approach to Teaching Musculoskeletal Physical Examination Skills Benefits Residents and Medical Students.

PubMed

Rosenberg, Casandra J; Nanos, Katherine N; Newcomer, Karen L

2017-03-01

The musculoskeletal physical examination (MSK PE) is an essential part of medical student training, and it is best taught in a hands-on, longitudinal fashion. A barrier to this approach is faculty instructor availability. "Near-peer" teaching refers to physicians-in-training teaching their junior colleagues. It is unknown whether near-peer teaching is effective in teaching this important physical examination skill. To investigate attitudes of medical students and physical medicine and rehabilitation (PM&R) residents regarding near-peer teaching in an MSK PE curriculum. Qualitative, anonymous paper and online surveys. Tertiary academic center with a medical school and PM&R training program. Ninety-nine second- and third-year medical students and 13 PM&R residents in their third or fourth postgraduate year. Attitudes of second- and third-year medical students were measured immediately after their MSK PE course. Resident attitudes were measured in a single cross-sectional sample. Student attitudes were assessed via a questionnaire with 5-point Likert scales and a free-text comment section. The resident questionnaire included a combination of multiple-choice questions, rankings, free-text responses, and Likert scales. All 99 students completed the questionnaire. The majority of students (n = 79 [80%]) reported that resident involvement as hands-on instructors of examination skills was "very useful," and 87 (88%) indicated that resident-led small discussion groups were "very helpful" or "somewhat helpful." Fifty-seven of 99 students (58%) reported that the resident-facilitated course was "much better" than courses without resident involvement. Twelve of 13 eligible residents completed the survey, and of those, 8 found teaching "very helpful" to their MSK knowledge, and 11 became "somewhat" or "much more confident" in clinical examination skills. Our study supports educational benefits to medical students and resident instructors in our MSK PE program. We recommend

Simulation Training in Obstetrics and Gynaecology Residency Programs in Canada.

PubMed

Sanders, Ari; Wilson, R Douglas

2015-11-01

The integration of simulation into residency programs has been slower in obstetrics and gynaecology than in other surgical specialties. The goal of this study was to evaluate the current use of simulation in obstetrics and gynaecology residency programs in Canada. A 19-question survey was developed and distributed to all 16 active and accredited obstetrics and gynaecology residency programs in Canada. The survey was sent to program directors initially, but on occasion was redirected to other faculty members involved in resident education or to senior residents. Survey responses were collected over an 18-month period. Twelve programs responded to the survey (11 complete responses). Eleven programs (92%) reported introducing an obstetrics and gynaecology simulation curriculum into their residency education. All respondents (100%) had access to a simulation centre. Simulation was used to teach various obstetrical and gynaecological skills using different simulation modalities. Barriers to simulation integration were primarily the costs of equipment and space and the need to ensure dedicated time for residents and educators. The majority of programs indicated that it was a priority for them to enhance their simulation curriculum and transition to competency-based resident assessment. Simulation training has increased in obstetrics and gynaecology residency programs. The development of formal simulation curricula for use in obstetrics and gynaecology resident education is in early development. A standardized national simulation curriculum would help facilitate the integration of simulation into obstetrics and gynaecology resident education and aid in the shift to competency-based resident assessment. Obstetrics and gynaecology residency programs need national collaboration (between centres and specialties) to develop a standardized simulation curriculum for use in obstetrics and gynaecology residency programs in Canada.

Small Intestine Cancer—Patient Version

Cancer.gov

Small intestine cancer usually begins in an area of the intestine called the duodenum. This cancer is rarer than cancers in other parts of the gastrointestinal system, such as the colon and stomach. Explore the links on this page to learn more about small intestine cancer treatment, statistics, research, and clinical t

The pediatric resident training on tobacco project: baseline findings from the Parent/Guardian Tobacco Survey.

PubMed

Hymowitz, Norman; Schwab, Joseph; Haddock, Christopher keith; Pyle, Sara; Moore, Glenisha; Meshberg, Sarah

2005-07-01

Pediatricians have an important and unique role to play in the anti-tobacco arena. They may prevent relapse to smoking in women who stopped smoking during pregnancy, encourage parents to protect infants and young children from environmental tobacco smoke (ETS), prevent the onset of smoking in children and adolescents, and help patients and parents who smoke or use other forms of tobacco to quit. Unfortunately, few pediatricians intervene on tobacco use or ETS, and few pediatric residency training programs prepare residents to address tobacco. The Pediatric Residency Training on Tobacco Project is a 4-year randomized prospective study of the effectiveness of training pediatric residents to intervene on tobacco in patients and parents. In this paper, we present findings from the Baseline Parent/Guardian Tobacco Survey. Fifteen pediatric residency training programs participated in the Pediatric Residency Training on Tobacco Project, and they were assigned randomly to special and standard training conditions. The Baseline Parent/Guardian Tobacco Survey was administered to 1770 participants, a minimum of 100 from each site. The Parent/Guardian Survey was designed to describe the population under study. It addressed demographic information, family tobacco use, rules concerning smoking in the home and elsewhere, smoking behavior and beliefs, and parent/guardian reports of resident intervention on tobacco. Data analyses described the population served by Continuity Clinics associated with the pediatric residency training programs and determined the degree to which residents addressed tobacco in parents/guardians. The parents/guardians were primarily low-income African American and Hispanic females. Approximately 20% reported that they smoked cigarettes, and about 60% prohibited smoking in their home. Seventy percent of the parents reported that the resident asked about cigarette smoking, and about half indicated that the resident talked with them about ETS. However, only

Gut symbiotic microbes imprint intestinal immune cells with the innate receptor SLAMF4 which contributes to gut immune protection against enteric pathogens

PubMed Central

Cabinian, Allison; Sinsimer, Daniel; Tang, May; Jang, Youngsoon; Choi, Bongkum; Laouar, Yasmina; Laouar, Amale

2018-01-01

Background Interactions between host immune cells and gut microbiota are crucial for the integrity and function of the intestine. How these interactions regulate immune cell responses in the intestine remains a major gap in the field. Aim We have identified the signalling lymphocyte activation molecule family member 4 (SLAMF4) as an immunomodulator of the intestinal immunity. The aim is to determine how SLAMF4 is acquired in the gut and what its contribution to intestinal immunity is. Methods Expression of SLAMF4 was assessed in mice and humans. The mechanism of induction was studied using GFPtg bone marrow chimaera mice, lymphotoxin α and TNLG8A-deficient mice, as well as gnotobiotic mice. Role in immune protection was revealed using oral infection with Listeria monocytogenes and Cytobacter rodentium. Results SLAMF4 is a selective marker of intestinal immune cells of mice and humans. SLAMF4 induction occurs directly in the intestinal mucosa without the involvement of the gut-associated lymphoid tissue. Gut bacterial products, particularly those of gut anaerobes, and gut-resident antigen-presenting cell (APC)TNLG8A are key contributors of SLAMF4 induction in the intestine. Importantly, lack of SLAMF4 expression leads the increased susceptibility of mice to infection by oral pathogens culminating in their premature death. Conclusions SLAMF4 is a marker of intestinal immune cells which contributes to the protection against enteric pathogens and whose expression is dependent on the presence of the gut microbiota. This discovery provides a possible mechanism for answering the long-standing question of how the intertwining of the host and gut microbial biology regulates immune cell responses in the gut. PMID:28341747

Internal Medicine Residency Program Directors' Views of the Core Entrustable Professional Activities for Entering Residency: An Opportunity to Enhance Communication of Competency Along the Continuum.

PubMed

Angus, Steven V; Vu, T Robert; Willett, Lisa L; Call, Stephanie; Halvorsen, Andrew J; Chaudhry, Saima

2017-06-01

To examine internal medicine (IM) residency program directors' (PDs') perspectives on the Core Entrustable Professional Activities for Entering Residency (Core EPAs)-introduced into undergraduate medical education to further competency-based assessment-and on communicating competency-based information during transitions. A spring 2015 Association of Program Directors in Internal Medicine survey asked PDs of U.S. IM residency programs for their perspectives on which Core EPAs new interns must or should possess on day 1, which are most essential, and which have the largest gap between expected and observed performance. Their views and preferences were also requested regarding communicating competency-based information at transitions from medical school to residency and residency to fellowship/employment. The response rate was 57% (204/361 programs). The majority of PDs felt new interns must/should possess 12 of the 13 Core EPAs. PDs' rankings of Core EPAs by relative importance were more varied than their rankings by the largest gaps in performance. Although preferred timing varied, most PDs (82%) considered it important for medical schools to communicate Core EPA-based information to PDs; nearly three-quarters (71%) would prefer a checklist format. Many (60%) would be willing to provide competency-based evaluations to fellowship directors/employers. Most (> 80%) agreed that there should be a bidirectional communication mechanism for programs/employers to provide feedback on competency assessments. The gaps identified in Core EPA performance may help guide medical schools' curricular and assessment tool design. Sharing competency-based information at transitions along the medical education continuum could help ensure production of competent, practice-ready physicians.

TH-E-201-00: Teaching Radiology Residents: What, How, and Expectation

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

The ABR Core Examination stresses integrating physics into real-world clinical practice and, accordingly, has shifted its focus from passive recall of facts to active application of physics principles. Physics education of radiology residents poses a challenge. The traditional method of didactic lectures alone is insufficient, yet it is difficult to incorporate physics teaching consistently into clinical rotations due to time constraints. Faced with this challenge, diagnostic medical physicists who teach radiology residents, have been thinking about how to adapt their teaching to the new paradigm, what to teach and meet expectation of the radiology resident and the radiology residency program.more » The proposed lecture attempts to discuss above questions. Newly developed diagnostic radiology residents physics curriculum by the AAPM Imaging Physics Curricula Subcommittee will be reviewed. Initial experience on hands-on physics teaching will be discussed. Radiology resident who will have taken the BAR Core Examination will share the expectation of physics teaching from a resident perspective. The lecture will help develop robust educational approaches to prepare radiology residents for safer and more effective lifelong practice. Learning Objectives: Learn updated physics requirements for radiology residents Pursue effective approaches to teach physics to radiology residents Learn expectation of physics teaching from resident perspective J. Zhang, This topic is partially supported by RSNA Education Scholar Grant.« less

Preresidency publication record and its association with publishing during paediatric residency.

PubMed

Gupta, Ronish; Norris, Mark Lorne; Writer, Hilary

2016-05-01

To determine whether an association exists between the publication of journal articles before and during paediatrics residency. A retrospective search of PubMed was conducted for publications by all 567 Canadian paediatricians certified between 2009 and 2012, inclusive. Paediatricians were separated into groups based on the number of articles published preresidency (0 or ≥1) and during residency (0 or ≥1). The methodology was validated using a group of local paediatricians who were contacted to verify whether their publications were identified accurately. A total of 160 of 567 (28%) certified paediatricians had preresidency publications; of these, 93 (58%) subsequently published during their residency period. Among the remaining 407 (72%) paediatricians without preresidency publications, 129 (32%) published during residency. The association between publication before and during paediatric residency was statistically significant (OR 2.98 [95% CI 2.04 to 4.36]; P<0.001). Results from the validation analysis suggested the methodology correctly identified pre- and during residency publication status with 87% and 90% accuracy, respectively. Individuals with previous publications were more likely to publish as residents; however, 42% of individuals with pre-residency publications did not publish as residents. Residency selection committees may find these data helpful in assessing the publication potential of their applicants. In addition, this information may assist in building more targeted and individualized research curricula within residency programs.

Role of Pharmacy Residency Training in Career Planning: A Student's Perspective.

PubMed

McElhaney, Ashley; Weber, Robert J

2014-12-01

Pharmacy students typically become more focused on career planning and assessment in the final year of their PharmD training. Weighing career options in the advanced pharmacy practice experience year can be both exciting and stressful. The goal of this article is to provide a primer on how pharmacy students can assess how a residency can fit into career planning. This article will describe the various career paths available to graduating students, highlight ways in which a residency can complement career choices, review the current state of the job market for pharmacists, discuss the current and future plans for residency programs, and present thoughts from some current and former residents on why they chose to complete a residency. Most career paths require some additional training, and a residency provides appropriate experience very quickly compared to on-the-job training. Alternative plans to residency training must also be considered, as there are not enough residency positions for candidates. Directors of pharmacy must consider several factors when giving career advice on pharmacy residency training to pharmacy students; they should provide the students with an honest assessment of their work skills and their abilities to successfully complete a residency. This assessment will help the students to set a plan for improvement and give them a better chance at being matched to a pharmacy residency.

TH-E-201-01: Diagnostic Radiology Residents Physics Curriculum and Updates

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sensakovic, W.

The ABR Core Examination stresses integrating physics into real-world clinical practice and, accordingly, has shifted its focus from passive recall of facts to active application of physics principles. Physics education of radiology residents poses a challenge. The traditional method of didactic lectures alone is insufficient, yet it is difficult to incorporate physics teaching consistently into clinical rotations due to time constraints. Faced with this challenge, diagnostic medical physicists who teach radiology residents, have been thinking about how to adapt their teaching to the new paradigm, what to teach and meet expectation of the radiology resident and the radiology residency program.more » The proposed lecture attempts to discuss above questions. Newly developed diagnostic radiology residents physics curriculum by the AAPM Imaging Physics Curricula Subcommittee will be reviewed. Initial experience on hands-on physics teaching will be discussed. Radiology resident who will have taken the BAR Core Examination will share the expectation of physics teaching from a resident perspective. The lecture will help develop robust educational approaches to prepare radiology residents for safer and more effective lifelong practice. Learning Objectives: Learn updated physics requirements for radiology residents Pursue effective approaches to teach physics to radiology residents Learn expectation of physics teaching from resident perspective J. Zhang, This topic is partially supported by RSNA Education Scholar Grant.« less

Resident-to-resident violence triggers in nursing homes.

PubMed

Snellgrove, Susan; Beck, Cornelia; Green, Angela; McSweeney, Jean C

2013-11-01

Certified nurses' assistants (CNAs) employed by a rural nursing home in Northeast Arkansas described their perceptions of resident-to-resident violence in order to provide insight on factors, including unmet needs, that may trigger the phenomenon. Semistructured interviews were conducted with 11 CNAs. Data were analyzed using content analysis and constant comparison. Two categories of triggers emerged from the data-active and passive. Active triggers involved the actions of other residents that were intrusive in nature, such as wandering into a residents' personal space, taking a resident's belongings, and so forth. Passive triggers did not involve the actions of residents but related to the internal and external environment of the residents. Examples were factors such as boredom, competition for attention and communication difficulties. Results indicate that there are factors, including unmet needs within the nursing home environment that may be identified and altered to prevent violence between residents.

Emergence and Kinetics of Simian Immunodeficiency Virus-Specific CD8+ T Cells in the Intestines of Macaques during Primary Infection

PubMed Central

Veazey, Ronald S.; Gauduin, Marie-Claire; Mansfield, Keith G.; Tham, Irene C.; Altman, John D.; Lifson, Jeffrey D.; Lackner, Andrew A.; Johnson, R. Paul

2001-01-01

In this report, three Mamu-A*01+ rhesus macaques were examined to compare the emergence of simian immunodeficiency virus (SIV)-specific CD8+ T cells in the intestines and blood in early SIV infection using a major histocompatibility complex class I tetramer complexed with the Gag181–189 peptide. Fourteen days after intravenous inoculation with SIVmac251, large numbers of SIV Gag181–189-specific CD8+ T cells were detected in the intestinal mucosa (3.1 to 11.5% of CD3+ CD8+ lymphocytes) as well as in the blood (3.1 to 13.4%) of all three macaques. By 21 days postinoculation, levels of tetramer-binding cells had dropped in both the intestines and blood. At day 63, however, levels of SIV Gag181–189-specific CD8+ T cells in the intestines had rebounded in all three macaques to levels that were higher (8.6 to 18.7%) than those at day 21. In contrast, percentages of tetramer-binding cells in the peripheral blood remained comparatively stable (2.5 to 4.5%) at this time point. In summary, SIV Gag181–189-specific CD8+ T cells appeared in both the intestinal mucosa and peripheral blood at a comparable rate and magnitude in primary SIV infection. Given that the intestine is a major site of early viral replication as well as the site where most of the total body lymphocyte pool resides, these data indicate that it is also an early and important site of development of antiviral immune responses. PMID:11581423

"The Actualized Neurosurgeon": A Proposed Model of Surgical Resident Development.

PubMed

Lipsman, Nir; Khan, Osaama; Kulkarni, Abhaya V

2017-03-01

Modern neurosurgical training is both physically and emotionally demanding, posing significant challenges, new and old, to residents as well as programs attempting to train safe, competent surgeons. Models to describe resident development, such as the Accreditation Council for Graduate Medical Education competencies and milestones, address the acquisition of specific skills but largely ignore the stresses and pressures unique to each stage of resident training. We propose an alternative model of resident development adapted from the developmental psychology literature. Our model identifies the challenges that must be met at each stage of junior, intermediate, and senior and chief residency, leading ultimately to an "actualized" neurosurgeon (i.e., one who has maximized his or her potential). Failure to overcome any 1 of these challenges can lead to specific long-lasting consequences, including regret, identity crisis, incompetence, and bitterness. In contrast, the actualized surgeon is one who has successfully acquired the virtues of hope, will, purpose, fidelity, productivity, leadership, competence, and wisdom. The actualized surgeon not only functions safely, confidently, and professionally, but also successfully navigates the challenges of residency and emerges from them having fulfilled his or her maximal potential. This developmental perspective provides an individualized description of healthy surgical development. Our model allows programs to identify the basis for residents who fail to progress, counsel residents during their training, and perhaps help identify resident candidates who are better prepared to meet the developmental challenges of residency training. Copyright © 2016 Elsevier Inc. All rights reserved.

Small intestinal bacterial overgrowth syndrome

PubMed Central

Bures, Jan; Cyrany, Jiri; Kohoutova, Darina; Förstl, Miroslav; Rejchrt, Stanislav; Kvetina, Jaroslav; Vorisek, Viktor; Kopacova, Marcela

2010-01-01

Human intestinal microbiota create a complex polymicrobial ecology. This is characterised by its high population density, wide diversity and complexity of interaction. Any dysbalance of this complex intestinal microbiome, both qualitative and quantitative, might have serious health consequence for a macro-organism, including small intestinal bacterial overgrowth syndrome (SIBO). SIBO is defined as an increase in the number and/or alteration in the type of bacteria in the upper gastrointestinal tract. There are several endogenous defence mechanisms for preventing bacterial overgrowth: gastric acid secretion, intestinal motility, intact ileo-caecal valve, immunoglobulins within intestinal secretion and bacteriostatic properties of pancreatic and biliary secretion. Aetiology of SIBO is usually complex, associated with disorders of protective antibacterial mechanisms (e.g. achlorhydria, pancreatic exocrine insufficiency, immunodeficiency syndromes), anatomical abnormalities (e.g. small intestinal obstruction, diverticula, fistulae, surgical blind loop, previous ileo-caecal resections) and/or motility disorders (e.g. scleroderma, autonomic neuropathy in diabetes mellitus, post-radiation enteropathy, small intestinal pseudo-obstruction). In some patients more than one factor may be involved. Symptoms related to SIBO are bloating, diarrhoea, malabsorption, weight loss and malnutrition. The gold standard for diagnosing SIBO is still microbial investigation of jejunal aspirates. Non-invasive hydrogen and methane breath tests are most commonly used for the diagnosis of SIBO using glucose or lactulose. Therapy for SIBO must be complex, addressing all causes, symptoms and complications, and fully individualised. It should include treatment of the underlying disease, nutritional support and cyclical gastro-intestinal selective antibiotics. Prognosis is usually serious, determined mostly by the underlying disease that led to SIBO. PMID:20572300

Coleadership Among Chief Residents: Exploration of Experiences Across Specialties

PubMed Central

Pettit, Jeffrey E.

2015-01-01

Background Many departments have multiple chief residents. How these coleaders relate to each other could affect their performance, the residency program, and the department. Objective This article reports on how co-chiefs work together during the chief year, and what may allow them to be more effective coleaders. Methods A phenomenological research design was used to investigate experiences of outgoing chief residents from 13 specialties at the University of Iowa Hospitals and Clinics over a 2-year period from 2012 through 2013. Thematic analysis of semistructured interviews was conducted to investigate commonalities and recommendations. Results Face-to-face interviews with 19 chief residents from 13 different specialties identified experiences that helped co-chiefs work effectively with each other in orienting new co-chiefs, setting goals and expectations, making decisions, managing interpersonal conflict, leadership styles, communicating, working with program directors, and providing evaluations and feedback. Although the interviewed chief residents received guidance on how to be an effective chief resident, none had been given advice on how to effectively work with a co-chief, and 26% (5 of 19) of the respondents reported having an ineffective working relationship with their co-chief. Conclusions Chief residents often colead in carrying out their multiple functions. To successfully function in a multichief environment, chief residents may benefit from a formal co-orientation in which they discuss goals and expectations, agree on a decision-making process, understand each other's leadership style, and receive feedback on their efficacy as leaders. PMID:26221435

Intestinal Adaptations in Chronic Kidney Disease and the Influence of Gastric Bypass Surgery

PubMed Central

Hatch, Marguerite

2015-01-01

Studies have shown that compensatory adaptations in gastrointestinal oxalate transport can impact the amount of oxalate excreted by the kidney. Hyperoxaluria is a major risk factor in the formation of kidney stones and oxalate is derived from both the diet as well as from liver metabolism of glyoxylate. Although the intestine generally absorbs oxalate from dietary sources, and can contribute as much as 50% of urinary oxalate, enteric oxalate elimination plays a significant role when renal function is compromised. While the mechanistic basis for these changes in the direction of intestinal oxalate movements in chronic renal failure involves an up-regulation of angiotensin II (ANG) receptors in the large intestine, enteric secretion/excretion of oxalate can also occur by mechanisms that are independent of ANG II. Most notably, the commensal bacterium Oxalobacter sp. interacts with the host enterocyte and promotes the movement of oxalate from blood into the lumen resulting in the beneficial effect of significantly lowering urinary oxalate excretion. Changes in the passive permeability of the intestine such as in steatorrhea and following gastric bypass also promote oxalate absorption and hyperoxaluria. In summary, this report highlights the two-way physiological signaling between the gut and the kidney which may help to alleviate the consequences of certain kidney diseases. PMID:24951497

Precision-cut intestinal slices: alternative model for drug transport, metabolism, and toxicology research.

PubMed

Li, Ming; de Graaf, Inge A M; Groothuis, Geny M M

2016-01-01

The absorption, distribution, metabolism, excretion and toxicity (ADME-tox) processes of drugs are of importance and require preclinical investigation intestine in addition to the liver. Various models have been developed for prediction of ADME-tox in the intestine. In this review, precision-cut intestinal slices (PCIS) are discussed and highlighted as model for ADME-tox studies. This review provides an overview of the applications and an update of the most recent research on PCIS as an ex vivo model to study the transport, metabolism and toxicology of drugs and other xenobiotics. The unique features of PCIS and the differences with other models as well as the translational aspects are also discussed. PCIS are a simple, fast, and reliable ex vivo model for drug ADME-tox research. Therefore, PCIS are expected to become an indispensable link in the in vitro-ex vivo-in vivo extrapolation, and a bridge in translation of animal data to the human situation. In the future, this model may be helpful to study the effects of interorgan interactions, intestinal bacteria, excipients and drug formulations on the ADME-tox properties of drugs. The optimization of culture medium and the development of a (cryo)preservation technique require more research.

Factors Influencing Resident Choice of Prosthodontic Residency Program.

PubMed

Wojnarwsky, Pandora Keala Lee; Wang, Yan; Shah, Kumar; Koka, Sreenivas

2017-06-01

The decision by prosthodontic residency program directors to employ the Match process highlights the need to understand applicant priorities that influence their choice of which programs to rank highly. The purpose of this study is to determine the factors that were most important to residents when choosing from among nonmilitary based prosthodontics dental residency programs in the United States. Following completion of a pilot study, all currently enrolled prosthodontic residents at nonmilitary residency programs were invited to participate via the internet. The study consisted of a survey instrument asking residents to rank 26 possible factors that might impact an applicant's choice of residency program. In addition, the instrument collected other possible influencing variables including gender and debt load. Mean rank scores were compared to determine the most and least important factors. Kruskal-Wallis test was used to compare specific factors between the possible influencing variables. Two hundred and thirty residents completed the survey instrument, representing a 54.1% response rate of possible participants. With regard to factors influencing program choice, reputation of the residency program was the factor ranked the highest by participants, followed in descending order by the program director's personality, curriculum content, access to use of the latest digital technology, and opportunities for dental implant placement. Quality of schools for children, community outreach opportunities, and the ability to moonlight were ranked as the least important factors. Male and female residents ranked factors such as tuition/stipend, curriculum content, and community outreach opportunities significantly differently. Depending on debt load, residents ranked the factors tuition/stipend, ability to moonlight, curriculum content, and safety of the area where the program is differently. Current prosthodontic residents valued the reputation of the program as the most

Fat-soluble vitamin intestinal absorption: absorption sites in the intestine and interactions for absorption.

PubMed

Goncalves, Aurélie; Roi, Stéphanie; Nowicki, Marion; Dhaussy, Amélie; Huertas, Alain; Amiot, Marie-Josèphe; Reboul, Emmanuelle

2015-04-01

The interactions occurring at the intestinal level between the fat-soluble vitamins A, D, E and K (FSVs) are poorly documented. We first determined each FSV absorption profile along the duodenal-colonic axis of mouse intestine to clarify their respective absorption sites. We then investigated the interactions between FSVs during their uptake by Caco-2 cells. Our data show that vitamin A was mostly absorbed in the mouse proximal intestine, while vitamin D was absorbed in the median intestine, and vitamin E and K in the distal intestine. Significant competitive interactions for uptake were then elucidated among vitamin D, E and K, supporting the hypothesis of common absorption pathways. Vitamin A also significantly decreased the uptake of the other FSVs but, conversely, its uptake was not impaired by vitamins D and K and even promoted by vitamin E. These results should be taken into account, especially for supplement formulation, to optimise FSV absorption. Copyright © 2014 Elsevier Ltd. All rights reserved.

Echinostoma ilocanum Infection in Two Residents of Savannakhet Province, Lao PDR

PubMed Central

Chai, Jong-Yil; Sohn, Woon-Mok; Cho, Jaeeun; Eom, Keeseon S.; Yong, Tai-Soon; Min, Duk-Young; Hoang, Eui-Hyug; Phommasack, Bounlay; Insisiengmay, Bounnaloth; Rim, Han-Jong

2018-01-01

Adult specimens of Echinostoma ilocanum (Garrison, 1908) Odhner, 1911 (Trematoda: Echinostomatidae) were recovered from 2 riparian people who resided along the Mekong River in Savannakhet Province, Lao PDR. In fecal examinations done by the Kato-Katz technique, they revealed echinostome eggs together with eggs of Opisthorchis viverrini (and minute intestinal fluke eggs) and hookworms. To recover the adult flukes, they were treated with praziquantel 30–40 mg/kg in a single dose and purged with magnesium salts. A total of 658 adult fluke specimens were recovered from the 2 people; 456 from case 1 and 202 from case 2. Specimens from case 1 consisted of 335 echinostomes (301 E. ilocanum and 34 species undetermined), 120 O. viverrini, and 1 Haplorchis taichui, and those from case 2 consisted of 36 E. ilocanum, 134 O. viverrini, and 32 H. taichui. Thus, the number of E. ilocanum specimens was 337 in total (average per person, 168.5). From this study, it is suggested that foodborne intestinal flukes and liver flukes are highly prevalent along the Mekong River in Savannakhet Province. The present report describes for the first time human infections with E. ilocanum in Lao PDR. PMID:29529854

Teaching Principles of Patient-Centered Care During Radiology Residency.

PubMed

Miller, Matthew M; Slanetz, Priscilla J; Lourenco, Ana P; Eisenberg, Ronald L; Kung, Justin W

2016-07-01

Patient-centered healthcare delivery has become increasingly established as a cornerstone of quality medical care, but teaching these principles in a radiology residency setting is often difficult and ineffective in a traditional lecture format. We developed a novel educational session in which actual patient letters about a healthcare provider are used to facilitate a case-based discussion of key principles of patient-centered care. A novel patient letter-facilitated, case-based session was conducted at two different university-based teaching institutions. Prior to the educational session, patient letters introducing the principles of patient-centered care were distributed to residents for review. During the session, radiology-specific cases were discussed in the context of the principles introduced by the letters. A post-session survey was administered to evaluate the efficacy and usefulness of the session. Forty-six of the 61 session attendees (75%) completed the post session survey. Most respondents (93%) preferred this case-based, interactive session to a typical didactic session. A majority of the residents indicated that both the patient letters (64%) and radiology specific cases (73%) helped them think differently about how they interact with patients. They indicated that the session enhanced their understanding of professionalism (3.7 out of 5.0 [95% CI 3.4-4.0]) and increased their motivation to become more patient-centered (3.0 out of 4.0 [95% CI 2.8-3.3]). Our findings suggest that patient letter-facilitated, case-based sessions may influence resident attitudes regarding the principles of patient-centered care and may help to increase resident motivation to become more patient-centered in their own practice. Copyright © 2016 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Thoracic surgery training in Canada according to the residents: the thoracic surgery resident survey, of the Canadian thoracic manpower and education study (T-Med).

PubMed

Schieman, Colin; Kelly, Elizabeth; Gelfand, Gary; Graham, Andrew; McFadden, Sean P; Edwards, Janet; Grondin, Sean C

2010-01-01

The resident component of the Canadian Thoracic Manpower and Education Study (T-MED) was conducted to understand the basic demographic of Canadian thoracic surgery residents, the factors influencing their selection of training programs, current work conditions, training and competencies, and opinions in regard to the manpower needs for the specialty. A modified Delphi process was used to develop a survey applicable to thoracic surgery residents. In May and June 2009, residents completed the voluntary anonymous Internet-based survey. All Canadian residents participated in the survey, providing a 100% response rate. Most respondents were male (11/12), and the average age was 34 years old with an anticipated debt greater than $50,000 on graduation. All residents worked more than 70 hours per week, with most doing 1 : 3 or 1 : 4 on-call. Two-thirds of respondents reported being satisfied or very satisfied with their training program. Rates of anticipated competence in performing various thoracic surgeries on graduation differed between residents and program directors. Two-thirds (8/12) of residents planned to practice thoracic surgery exclusively, and hoped to practice in an academic setting. Most residents (10/12) agreed or strongly agreed that not enough jobs are available in Canada for graduating trainees and that the number of residency positions should reflect the predicted availability of jobs. This study has provided detailed information on thoracic surgery resident demographics and training programs. Most thoracic surgery residents are satisfied with their current training program but have concerns about their job prospects on graduation, and they believe that the number of training positions should reflect potential job opportunities. This survey represents the first attempt to characterize the current state of thoracic surgery training in Canada from the resident's perspective and may help in directing educational and manpower planning. Copyright © 2010

Adult zebrafish intestine resection: a novel model of short bowel syndrome, adaptation, and intestinal stem cell regeneration.

PubMed

Schall, K A; Holoyda, K A; Grant, C N; Levin, D E; Torres, E R; Maxwell, A; Pollack, H A; Moats, R A; Frey, M R; Darehzereshki, A; Al Alam, D; Lien, C; Grikscheit, T C

2015-08-01

Loss of significant intestinal length from congenital anomaly or disease may lead to short bowel syndrome (SBS); intestinal failure may be partially offset by a gain in epithelial surface area, termed adaptation. Current in vivo models of SBS are costly and technically challenging. Operative times and survival rates have slowed extension to transgenic models. We created a new reproducible in vivo model of SBS in zebrafish, a tractable vertebrate model, to facilitate investigation of the mechanisms of intestinal adaptation. Proximal intestinal diversion at segment 1 (S1, equivalent to jejunum) was performed in adult male zebrafish. SBS fish emptied distal intestinal contents via stoma as in the human disease. After 2 wk, S1 was dilated compared with controls and villus ridges had increased complexity, contributing to greater villus epithelial perimeter. The number of intervillus pockets, the intestinal stem cell zone of the zebrafish increased and contained a higher number of bromodeoxyuridine (BrdU)-labeled cells after 2 wk of SBS. Egf receptor and a subset of its ligands, also drivers of adaptation, were upregulated in SBS fish. Igf has been reported as a driver of intestinal adaptation in other animal models, and SBS fish exposed to a pharmacological inhibitor of the Igf receptor failed to demonstrate signs of intestinal adaptation, such as increased inner epithelial perimeter and BrdU incorporation. We describe a technically feasible model of human SBS in the zebrafish, a faster and less expensive tool to investigate intestinal stem cell plasticity as well as the mechanisms that drive intestinal adaptation. Copyright © 2015 the American Physiological Society.

Adult zebrafish intestine resection: a novel model of short bowel syndrome, adaptation, and intestinal stem cell regeneration

PubMed Central

Schall, K. A.; Holoyda, K. A.; Grant, C. N.; Levin, D. E.; Torres, E. R.; Maxwell, A.; Pollack, H. A.; Moats, R. A.; Frey, M. R.; Darehzereshki, A.; Al Alam, D.; Lien, C.

2015-01-01

Loss of significant intestinal length from congenital anomaly or disease may lead to short bowel syndrome (SBS); intestinal failure may be partially offset by a gain in epithelial surface area, termed adaptation. Current in vivo models of SBS are costly and technically challenging. Operative times and survival rates have slowed extension to transgenic models. We created a new reproducible in vivo model of SBS in zebrafish, a tractable vertebrate model, to facilitate investigation of the mechanisms of intestinal adaptation. Proximal intestinal diversion at segment 1 (S1, equivalent to jejunum) was performed in adult male zebrafish. SBS fish emptied distal intestinal contents via stoma as in the human disease. After 2 wk, S1 was dilated compared with controls and villus ridges had increased complexity, contributing to greater villus epithelial perimeter. The number of intervillus pockets, the intestinal stem cell zone of the zebrafish increased and contained a higher number of bromodeoxyuridine (BrdU)-labeled cells after 2 wk of SBS. Egf receptor and a subset of its ligands, also drivers of adaptation, were upregulated in SBS fish. Igf has been reported as a driver of intestinal adaptation in other animal models, and SBS fish exposed to a pharmacological inhibitor of the Igf receptor failed to demonstrate signs of intestinal adaptation, such as increased inner epithelial perimeter and BrdU incorporation. We describe a technically feasible model of human SBS in the zebrafish, a faster and less expensive tool to investigate intestinal stem cell plasticity as well as the mechanisms that drive intestinal adaptation. PMID:26089336

Small Intestinal Infections.

PubMed

Munot, Khushboo; Kotler, Donald P

2016-06-01

Small intestinal infections are extremely common worldwide. They may be bacterial, viral, or parasitic in etiology. Most are foodborne or waterborne, with specific etiologies differing by region and with diverse pathophysiologies. Very young, very old, and immune-deficient individuals are the most vulnerable to morbidity or mortality from small intestinal infections. There have been significant advances in diagnostic sophistication with the development and early application of molecular diagnostic assays, though these tests have not become mainstream. The lack of rapid diagnoses combined with the self-limited nature of small intestinal infections has hampered the development of specific and effective treatments other than oral rehydration. Antibiotics are not indicated in the absence of an etiologic diagnosis, and not at all in the case of some infections.

Intestinal Microbiota in Healthy Adults: Temporal Analysis Reveals Individual and Common Core and Relation to Intestinal Symptoms

PubMed Central

Nikkilä, Janne; Immonen, Outi; Kekkonen, Riina; Lahti, Leo; Palva, Airi; de Vos, Willem M.

2011-01-01

Background While our knowledge of the intestinal microbiota during disease is accumulating, basic information of the microbiota in healthy subjects is still scarce. The aim of this study was to characterize the intestinal microbiota of healthy adults and specifically address its temporal stability, core microbiota and relation with intestinal symptoms. We carried out a longitudinal study by following a set of 15 healthy Finnish subjects for seven weeks and regularly assessed their intestinal bacteria and archaea with the Human Intestinal Tract (HIT)Chip, a phylogenetic microarray, in conjunction with qPCR analyses. The health perception and occurrence of intestinal symptoms was recorded by questionnaire at each sampling point. Principal Findings A high overall temporal stability of the microbiota was observed. Five subjects showed transient microbiota destabilization, which correlated not only with the intake of antibiotics but also with overseas travelling and temporary illness, expanding the hitherto known factors affecting the intestinal microbiota. We identified significant correlations between the microbiota and common intestinal symptoms, including abdominal pain and bloating. The most striking finding was the inverse correlation between Bifidobacteria and abdominal pain: subjects who experienced pain had over five-fold less Bifidobacteria compared to those without pain. Finally, a novel computational approach was used to define the common core microbiota, highlighting the role of the analysis depth in finding the phylogenetic core and estimating its size. The in-depth analysis suggested that we share a substantial number of our intestinal phylotypes but as they represent highly variable proportions of the total community, many of them often remain undetected. Conclusions/Significance A global and high-resolution microbiota analysis was carried out to determine the temporal stability, the associations with intestinal symptoms, and the individual and common

Expert training with standardized operative technique helps establish a successful penile prosthetics program for urologic resident education.

PubMed

King, Ashley B; Klausner, Adam P; Johnson, Corey M; Moore, Blake W; Wilson, Steven K; Grob, B Mayer

2011-10-01

The challenge of resident education in urologic surgery programs is to overcome disparity imparted by diverse patient populations, limited training times, and inequalities in the availability of expert surgical educators. Specifically, in the area of prosthetic urology, only a small proportion of programs have full-time faculty available to train residents in this discipline. To examine whether a new model using yearly training sessions from a recognized expert can establish a successful penile prosthetics program and result in better outcomes, higher case volumes, and willingness to perform more complex surgeries. A recognized expert conducted one to two operative training sessions yearly to teach standardized technique for penile prosthetics to residents. Each session consisted of three to four operative cases performed under the direct supervision of the expert. Retrospective data were collected from all penile prosthetic operations before (February, 2000 to June, 2004: N = 44) and after (July, 2004 to October, 2007: N = 79) implementation of these sessions. Outcomes reviewed included patient age, race, medical comorbidities, operative time, estimated blood loss, type of prosthesis, operative approach, drain usage, length of stay, and complications including revision/explantation rates. Statistical analysis was performed using Student's t-tests, Fisher's tests, and survival curves using the Kaplan-Meier technique (P value ≤ 0.05 to define statistical significance). Patient characteristics were not significantly different pre- vs. post-training. Operative time and estimated blood loss significantly decreased. Inflatable implants increased from 19/44 (43.2%, pre-training) to 69/79 (87.3%, post-training) (P < 0.01). Operations per year increased from 9.96 (pre-training) to 24 (post-training) (P < 0.01). Revision/explantation occurred in 11/44 patients (25%, pre-training) vs. 7/79 (8.9%, post-training) (P < 0.05). These data demonstrate that yearly sessions with a

Small Intestine Cancer—Health Professional Version

Cancer.gov

Adenocarcinoma is the most common type of small intestine cancer. Other types of small intestine cancer are sarcomas, carcinoid tumors, gastrointestinal stromal tumors, and lymphomas. Find evidence-based information on small intestine cancer treatment, research, and statistics.

Changes in intestinal microbiota composition and metabolism coincide with increased intestinal permeability in young adults under prolonged physiological stress.

PubMed

Karl, J Philip; Margolis, Lee M; Madslien, Elisabeth H; Murphy, Nancy E; Castellani, John W; Gundersen, Yngvar; Hoke, Allison V; Levangie, Michael W; Kumar, Raina; Chakraborty, Nabarun; Gautam, Aarti; Hammamieh, Rasha; Martini, Svein; Montain, Scott J; Pasiakos, Stefan M

2017-06-01

The magnitude, temporal dynamics, and physiological effects of intestinal microbiome responses to physiological stress are poorly characterized. This study used a systems biology approach and a multiple-stressor military training environment to determine the effects of physiological stress on intestinal microbiota composition and metabolic activity, as well as intestinal permeability (IP). Soldiers ( n = 73) were provided three rations per day with or without protein- or carbohydrate-based supplements during a 4-day cross-country ski-march (STRESS). IP was measured before and during STRESS. Blood and stool samples were collected before and after STRESS to measure inflammation, stool microbiota, and stool and plasma global metabolite profiles. IP increased 62 ± 57% (mean ± SD, P < 0.001) during STRESS independent of diet group and was associated with increased inflammation. Intestinal microbiota responses were characterized by increased α-diversity and changes in the relative abundance of >50% of identified genera, including increased abundance of less dominant taxa at the expense of more dominant taxa such as Bacteroides Changes in intestinal microbiota composition were linked to 23% of metabolites that were significantly altered in stool after STRESS. Together, pre-STRESS Actinobacteria relative abundance and changes in serum IL-6 and stool cysteine concentrations accounted for 84% of the variability in the change in IP. Findings demonstrate that a multiple-stressor military training environment induced increases in IP that were associated with alterations in markers of inflammation and with intestinal microbiota composition and metabolism. Associations between IP, the pre-STRESS microbiota, and microbiota metabolites suggest that targeting the intestinal microbiota could provide novel strategies for preserving IP during physiological stress. NEW & NOTEWORTHY Military training, a unique model for studying temporal dynamics of intestinal barrier and intestinal

Computerized rounding in a community hospital surgery residency program.

PubMed

Park, John; Tymitz, Kevin; Engel, Amy M; Welling, Richard E

2007-01-01

and post-PDA round time at 40.7 minutes (p = 0.02). Results of this study support the hypothesis that the prerounding time dramatically decreases with the PDA compared to without. Not only does this decrease in time help to keep residents under the 80-hour work week rule, but also it helps to eliminate much of the confusion that can cause patient safety issues.

Parenteral Nutrition and Intestinal Failure.

PubMed

Bielawska, Barbara; Allard, Johane P

2017-05-06

Severe short bowel syndrome (SBS) is a major cause of chronic (Type 3) intestinal failure (IF) where structural and functional changes contribute to malabsorption and risk of micronutrient deficiencies. Chronic IF may be reversible, depending on anatomy and intestinal adaptation, but most patients require long-term nutritional support, generally in the form of parenteral nutrition (PN). SBS management begins with dietary changes and pharmacologic therapies taking into account individual anatomy and physiology, but these are rarely sufficient to avoid PN. New hormonal therapies targeting intestinal adaptation hold promise. Surgical options for SBS including intestinal transplant are available, but have significant limitations. Home PN (HPN) is therefore the mainstay of treatment for severe SBS. HPN involves chronic administration of macronutrients, micronutrients, fluid, and electrolytes via central venous access in the patient's home. HPN requires careful clinical and biochemical monitoring. Main complications of HPN are related to venous access (infection, thrombosis) and metabolic complications including intestinal failure associated liver disease (IFALD). Although HPN significantly impacts quality of life, outcomes are generally good and survival is mostly determined by the underlying disease. As chronic intestinal failure is a rare disease, registries are a promising strategy for studying HPN patients to improve outcomes.

Occupational necessity and educational invention: resident teaching of radiologic technologists.

PubMed

Gunderman, Richard B; Fraley, Ronald; Jackson, Valerie; Robinson, Susan; Williamson, Kenneth

2003-04-01

Radiology faces a severe and growing shortage of radiologic technologists. One way of redressing this problem is to improve the quality of education provided to radiologic technology students. Yet growing clinical demands increasingly erode faculty time for teaching. This study examined whether radiology residents could provide equivalent instruction in radiologic technology at lower cost, and whether such experience could enhance residents' interest in teaching as part of their careers. Course evaluation forms completed by the students in a required radiologic pathology course were reviewed, and student-reported faculty and resident performances in teaching were compared. Residents also were surveyed for their reactions to the experience of teaching this course. Ninety percent of students (27 of 30) either agreed or strongly agreed that the course was well taught by radiology faculty members, and 97% (29 of 30) either agreed or strongly agreed that the course was well taught by radiology residents. The total direct cost of instruction by radiology residents was 73% lower than the cost of instruction by faculty. Residents who participated in teaching found the experience worthwhile, and they described a wide variety of personal and educational benefits. Involving radiology residents in teaching can help redress the growing shortage of radiologic technologists, relieve some of the pressure on faculty time, and contribute to the professional development of the next generation of radiologists.

Resident evaluation of clinical teachers based on teachers' certification.

PubMed

Steiner, Ivan P; Yoon, Philip W; Kelly, Karen D; Diner, Barry M; Donoff, Michel G; Mackey, Duncan S; Rowe, Brian H

2003-07-01

To examine the influence of emergency medicine (EM) certification of clinical teaching faculty on evaluations provided by residents. A prospective cohort analysis was conducted of assessments between July 1994 and July 2000 on residents' evaluations of EM faculty at the University of Alberta, Edmonton, Canada. Resident- and faculty-related variables were entered anonymously using the validated evaluation tool (ER Scale). Credentialing and demographic information on EM faculty was supplemented by data obtained through a nine-question survey. Groups were compared using ANOVA. The 562 residents returned 705 (91%) valid evaluation sheets on 115 EM faculty members. The four domains of didactic teaching, clinical teaching, approachability, and helpfulness were assessed. The majority of ratings were in the very good or superb categories for each domain. Instructors with certification in EM had higher scores in didactic, clinical teaching compared with others, and teachers without national certification scored lower in the helpful and approachable categories (p < 0.05). The route of obtaining EM certifications either through training or practice eligibility did not affect scores. Instructors under the age of 40 years had higher scores than the older age groups in three of four categories (p < 0.05). Instructors working at the teaching sites on a half-time basis received higher scores than those working full-time, and scores varied based on site. Overall, teaching ratings improved over the study period (p < 0.05). Significant differences exist among instructors in the EM setting that affect their teaching rating scores. National certification in EM, academic track, rotation year, and site are all correlated with better teaching performance.

CPSP/HSE Postgraduate Overseas Rotational Programme: Residents' Perspective.

PubMed

Gondal, Khalid Masood; Iqbal, Uzma; Arif, Seema; Ahmed, Arslan; Khan, Umair Ahmed

2016-04-01

To get direct upward feedback from the residents of first batch of CPSP/HSE Postgraduate Scholarship Programme. Mixed methods qualitative research study. CPSP, Regional Office, Lahore, in June 2015. It is a mixed-method study that was conducted in June, 2015. Data was collected through an email survey with 33 medical residents doing their rotation in Ireland; and focus group discussions were carried out with 8 residents, who had successfully completed their rotation. Data were collected through pre-designed questionnaires comprising of open- and close-ended questions. The data were entered into SPSS version 21 and analyzed. The mean age of residents was 29.9 &plusmn;1.1 years, 7 (21.2%) were females and 24 (72.7%) respondents were males. Residents agreed that HSE programme has improved their evidence-based decision making (mean score of 3.3 &plusmn;1.2) and enhanced professionalism (mean score of 3.6 &plusmn;1.1). They disagreed that training has polished their procedural skills (mean score 2.4 &plusmn;1.2). The identified strengths of the programme are: adopting a systematic approach towards patients, evidence-based decision making, better exposure and opportunities, financial stability and development of communication skills. The weaknesses are: less exposure to procedural skills, difficulty in synopsis and dissertation writing and difficulty in adjustment with rotational schedules. Residents of CPSP/HSE Programme believed that CPSP/HSE has improved their professionalism, communication skills and increased their future opportunities for career growth. Better communication between CPSP focal person and residents will help sort out many minor but important issues.

Weaving public health education into the fabric of a family medicine residency.

PubMed

Potts, Stacy E; Deligiannidis, Konstantinos E; Cashman, Suzanne B; Caggiano, Marie E; Carter, Lisa H; Haley, Heather-Lyn; Ferguson, Warren J

2011-10-01

Policymakers and accrediting bodies have recognized the importance of integrating public health, population health, and prevention into graduate medical education programs. The high prevalence of chronic illness, coupled with the impact of behavioral and societal determinants of health, necessitate an urgent call for family medicine residencies to prepare future leaders to meet these challenges. The University of Massachusetts Worcester Family Medicine Residency recently developed an integrated curriculum that strives to develop a culture of incorporating fundamental public health principles into everyday practice. This public health curriculum was designed to integrate new topics within the current residency structure through longitudinal and concentrated experiences. This strategy has substantially improved public health and prevention education without substantial impact on the already strained residency curricular structure. This paper describes the integration of public health and prevention education into a family medicine residency to help residents acquire the fundamental skills necessary to improve a population's health. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Primary intestinal lymphangiectasia (Waldmann's disease).

PubMed

Vignes, Stéphane; Bellanger, Jérôme

2008-02-22

Primary intestinal lymphangiectasia (PIL) is a rare disorder characterized by dilated intestinal lacteals resulting in lymph leakage into the small bowel lumen and responsible for protein-losing enteropathy leading to lymphopenia, hypoalbuminemia and hypogammaglobulinemia. PIL is generally diagnosed before 3 years of age but may be diagnosed in older patients. Prevalence is unknown. The main symptom is predominantly bilateral lower limb edema. Edema may be moderate to severe with anasarca and includes pleural effusion, pericarditis or chylous ascites. Fatigue, abdominal pain, weight loss, inability to gain weight, moderate diarrhea or fat-soluble vitamin deficiencies due to malabsorption may also be present. In some patients, limb lymphedema is associated with PIL and is difficult to distinguish lymphedema from edema. Exsudative enteropathy is confirmed by the elevated 24-h stool alpha1-antitrypsin clearance. Etiology remains unknown. Very rare familial cases of PIL have been reported. Diagnosis is confirmed by endoscopic observation of intestinal lymphangiectasia with the corresponding histology of intestinal biopsy specimens. Videocapsule endoscopy may be useful when endoscopic findings are not contributive. Differential diagnosis includes constrictive pericarditis, intestinal lymphoma, Whipple's disease, Crohn's disease, intestinal tuberculosis, sarcoidosis or systemic sclerosis. Several B-cell lymphomas confined to the gastrointestinal tract (stomach, jejunum, midgut, ileum) or with extra-intestinal localizations were reported in PIL patients. A low-fat diet associated with medium-chain triglyceride supplementation is the cornerstone of PIL medical management. The absence of fat in the diet prevents chyle engorgement of the intestinal lymphatic vessels thereby preventing their rupture with its ensuing lymph loss. Medium-chain triglycerides are absorbed directly into the portal venous circulation and avoid lacteal overloading. Other inconsistently effective

Primary intestinal lymphangiectasia (Waldmann's disease)

PubMed Central

Vignes, Stéphane; Bellanger, Jérôme

2008-01-01

Primary intestinal lymphangiectasia (PIL) is a rare disorder characterized by dilated intestinal lacteals resulting in lymph leakage into the small bowel lumen and responsible for protein-losing enteropathy leading to lymphopenia, hypoalbuminemia and hypogammaglobulinemia. PIL is generally diagnosed before 3 years of age but may be diagnosed in older patients. Prevalence is unknown. The main symptom is predominantly bilateral lower limb edema. Edema may be moderate to severe with anasarca and includes pleural effusion, pericarditis or chylous ascites. Fatigue, abdominal pain, weight loss, inability to gain weight, moderate diarrhea or fat-soluble vitamin deficiencies due to malabsorption may also be present. In some patients, limb lymphedema is associated with PIL and is difficult to distinguish lymphedema from edema. Exsudative enteropathy is confirmed by the elevated 24-h stool α1-antitrypsin clearance. Etiology remains unknown. Very rare familial cases of PIL have been reported. Diagnosis is confirmed by endoscopic observation of intestinal lymphangiectasia with the corresponding histology of intestinal biopsy specimens. Videocapsule endoscopy may be useful when endoscopic findings are not contributive. Differential diagnosis includes constrictive pericarditis, intestinal lymphoma, Whipple's disease, Crohn's disease, intestinal tuberculosis, sarcoidosis or systemic sclerosis. Several B-cell lymphomas confined to the gastrointestinal tract (stomach, jejunum, midgut, ileum) or with extra-intestinal localizations were reported in PIL patients. A low-fat diet associated with medium-chain triglyceride supplementation is the cornerstone of PIL medical management. The absence of fat in the diet prevents chyle engorgement of the intestinal lymphatic vessels thereby preventing their rupture with its ensuing lymph loss. Medium-chain triglycerides are absorbed directly into the portal venous circulation and avoid lacteal overloading. Other inconsistently effective

Prevalence and Risk Factors of Human Intestinal Parasites in Roudehen, Tehran Province, Iran.

PubMed

Hemmati, Nasrin; Razmjou, Elham; Hashemi-Hafshejani, Saeideh; Motevalian, Abbas; Akhlaghi, Lameh; Meamar, Ahmad Reza

2017-01-01

Intestinal parasitic infections are among the most common infections and health problems worldwide. Due to the lack of epidemiologic information of such infections, the prevalence of, and the risk factors for, enteric parasites were investigated in residents of Roudehen, Tehran Province, Iran. In this cross-sectional study, 561 triple fecal samples were collected through a two-stage cluster-sampling protocol from Jun to Dec 2014. The samples were examined by formalin-ether concentration, culture, and with molecular methods. The prevalence of enteric parasites was 32.7% (95% CI 27.3-38). Blastocystis sp. was the most common intestinal protozoan (28.4%; 95% CI 23.7-33.0). The formalin-ether concentration and culture methods detected Blastocystis sp., Entamoeba coli , Giardia intestinalis , Dientamoeba fragilis , Iodamoeba butschlii , Entamoeba complex cysts or trophozoite , Chilomastix mesnilii , and Enterobius vermicularis . Single-round PCR assay for Entamoeba complex were identified Entamoeba dispar and E. moshkovskii . E. histolytica was not observed in any specimen. Multivariate analysis showed a significant association of parasites with water source and close animal contact. There was no correlation between infections and gender, age, occupation, education, or travel history. Protozoan infections were more common than helminth infections. This study revealed a high prevalence of enteric protozoan parasite infection among citizens of Rodehen. As most of the species detected are transmitted through a water-resistant cyst, public and individual education on personal hygiene should be considered to reduce transmission of intestinal parasites in the population.

Gut symbiotic microbes imprint intestinal immune cells with the innate receptor SLAMF4 which contributes to gut immune protection against enteric pathogens.

PubMed

Cabinian, Allison; Sinsimer, Daniel; Tang, May; Jang, Youngsoon; Choi, Bongkum; Laouar, Yasmina; Laouar, Amale

2018-05-01

Interactions between host immune cells and gut microbiota are crucial for the integrity and function of the intestine. How these interactions regulate immune cell responses in the intestine remains a major gap in the field. We have identified the signalling lymphocyte activation molecule family member 4 (SLAMF4) as an immunomodulator of the intestinal immunity. The aim is to determine how SLAMF4 is acquired in the gut and what its contribution to intestinal immunity is. Expression of SLAMF4 was assessed in mice and humans. The mechanism of induction was studied using GFP tg bone marrow chimaera mice, lymphotoxin α and TNLG8A-deficient mice, as well as gnotobiotic mice. Role in immune protection was revealed using oral infection with Listeria monocytogenes and Cytobacter rodentium . SLAMF4 is a selective marker of intestinal immune cells of mice and humans. SLAMF4 induction occurs directly in the intestinal mucosa without the involvement of the gut-associated lymphoid tissue. Gut bacterial products, particularly those of gut anaerobes, and gut-resident antigen-presenting cell (APC) TNLG8A are key contributors of SLAMF4 induction in the intestine. Importantly, lack of SLAMF4 expression leads the increased susceptibility of mice to infection by oral pathogens culminating in their premature death. SLAMF4 is a marker of intestinal immune cells which contributes to the protection against enteric pathogens and whose expression is dependent on the presence of the gut microbiota. This discovery provides a possible mechanism for answering the long-standing question of how the intertwining of the host and gut microbial biology regulates immune cell responses in the gut. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

A Professionalism Curricular Model to Promote Transformative Learning Among Residents.

PubMed

Foshee, Cecile M; Mehdi, Ali; Bierer, S Beth; Traboulsi, Elias I; Isaacson, J Harry; Spencer, Abby; Calabrese, Cassandra; Burkey, Brian B

2017-06-01

Using the frameworks of transformational learning and situated learning theory, we developed a technology-enhanced professionalism curricular model to build a learning community aimed at promoting residents' self-reflection and self-awareness. The RAPR model had 4 components: (1) R ecognize : elicit awareness; (2) A ppreciate : question assumptions and take multiple perspectives; (3) P ractice : try new/changed perspectives; and (4) R eflect : articulate implications of transformed views on future actions. The authors explored the acceptability and practicality of the RAPR model in teaching professionalism in a residency setting, including how residents and faculty perceive the model, how well residents carry out the curricular activities, and whether these activities support transformational learning. A convenience sample of 52 postgraduate years 1 through 3 internal medicine residents participated in the 10-hour curriculum over 4 weeks. A constructivist approach guided the thematic analysis of residents' written reflections, which were a required curricular task. A total of 94% (49 of 52) of residents participated in 2 implementation periods (January and March 2015). Findings suggested that RAPR has the potential to foster professionalism transformation in 3 domains: (1) attitudinal, with participants reporting they viewed professionalism in a more positive light and felt more empathetic toward patients; (2) behavioral, with residents indicating their ability to listen to patients increased; and (3) cognitive, with residents indicating the discussions improved their ability to reflect, and this helped them create meaning from experiences. Our findings suggest that RAPR offers an acceptable and practical strategy to teach professionalism to residents.

Mechanisms of small intestinal adaptation.

PubMed

Jenkins, A P; Thompson, R P

1994-01-01

Luminal nutrition, hormonal factors and pancreaticobiliary secretions are probably the major mediators of small intestinal adaptation. Their actions, as discussed in this paper, are likely to be interrelated. Direct local enterotrophic effects cannot account for all the actions of luminal nutrients. Additionally, hormonal factors have been shown to contribute to indirect effects of luminal nutrients and enteroglucagon is a likely mediator of adaptive responses. Furthermore, epidermal growth factor is a peptide for which there is convincing evidence of an enterotrophic action. Attention is drawn to the fact that pancreaticobiliary secretions may have a physiological role in stimulating small intestinal mucosal proliferation. Other factors may also influence small intestinal mucosal proliferation (e.g. prostaglandins, neurovascular mechanisms, bacteria). Additionally, polyamines are crucial in initiating cell division in the small intestine, but the detailed mechanisms of their action require further clarification. Finally, a number of therapeutic applications of small intestinal epithelial cell proliferation are discussed.

Practice management education during surgical residency.

PubMed

Jones, Kory; Lebron, Ricardo A; Mangram, Alicia; Dunn, Ernest

2008-12-01

. These needs will be present whether pursuing a career in academic medicine or the private sector. A program that focuses on the business aspect of surgery enables the residents to better navigate the future while helping to fulfill the systems-based practice competency.

Prophylactic Ozone Administration Reduces Intestinal Mucosa Injury Induced by Intestinal Ischemia-Reperfusion in the Rat

PubMed Central

Onal, Ozkan; Yetisir, Fahri; Sarer, A. Ebru Salman; Zeybek, N. Dilara; Onal, C. Oztug; Yurekli, Banu; Celik, H. Tugrul; Sirma, Ayse; Kılıc, Mehmet

2015-01-01

Objectives. Intestinal ischemia-reperfusion injury is associated with mucosal damage and has a high rate of mortality. Various beneficial effects of ozone have been shown. The aim of the present study was to show the effects of ozone in ischemia reperfusion model in intestine. Material and Method. Twenty eight Wistar rats were randomized into four groups with seven rats in each group. Control group was administered serum physiologic (SF) intraperitoneally (ip) for five days. Ozone group was administered 1 mg/kg ozone ip for five days. Ischemia Reperfusion (IR) group underwent superior mesenteric artery occlusion for one hour and then reperfusion for two hours. Ozone + IR group was administered 1 mg/kg ozone ip for five days and at sixth day IR model was applied. Rats were anesthetized with ketamine∖xyzlazine and their intracardiac blood was drawn completely and they were sacrificed. Intestinal tissue samples were examined under light microscope. Levels of superoxide dismutase (SOD), catalase (CAT), glutathioneperoxidase (GSH-Px), malondyaldehide (MDA), and protein carbonyl (PCO) were analyzed in tissue samples. Total oxidant status (TOS), and total antioxidant capacity (TAC) were analyzed in blood samples. Data were evaluated statistically by Kruskal Wallis test. Results. In the ozone administered group, degree of intestinal injury was not different from the control group. IR caused an increase in intestinal injury score. The intestinal epithelium maintained its integrity and decrease in intestinal injury score was detected in Ozone + IR group. SOD, GSH-Px, and CAT values were high in ozone group and low in IR. TOS parameter was highest in the IR group and the TAC parameter was highest in the ozone group and lowest in the IR group. Conclusion. In the present study, IR model caused an increase in intestinal injury.In the present study, ozone administration had an effect improving IR associated tissue injury. In the present study, ozone therapy prevented

Intestinal toxicity evaluation of long-circulating and pH-sensitive liposomes loaded with cisplatin.

PubMed

Araújo, Raquel Silva; Silveira, Ana Letícia Malheiros; de Sales E Souza, Éricka Lorenna; Freire, Rachel Horta; de Souza, Cristina Maria; Reis, Diego Carlos; Costa, Bruno Rocha Cordeiro; Sugimoto, Michelle Amantéa; Silveira, Josianne Nicácio; Dos Santos Martins, Flaviano; Cassali, Geovanni Dantas; Leite, Jacqueline Isaura Alvarez; Sousa, Lirlândia Pires; Ferreira, Adaliene Versiani Matos; Oliveira, Mônica Cristina; Cardoso, Valbert Nascimento

2017-08-30

Cisplatin (CDDP) is a chemotherapeutic agent widely used in several anticancer protocols for instance head and neck, testicle, ovarian, lung and peritoneal carcinomatosis. According to the literature, the use of CDDP is associated with several side effects; among them, we highlighted the mucositis. CDDP, when administered by IP, promoted significant intestinal epithelium alterations in an experimental model. Our research group has proposed that the incorporation of CDDP into long-circulating and pH-sensitive liposomes (SpHL-CDDP) could help to overcome some side effects induced by this drug. Thus, we evaluated signs of intestinal toxicity 24h and 72h after the administration of a single i.p dose of free CDDP or SpHL-CDDP to healthy Swiss mice. Twenty-four hours after administration of free CDDP, the mice showed signs of intestinal toxicity, principally weight loss, increased intestinal permeability associated with a decrease in expression of tight junctions, and histological damage with the presence of inflammatory infiltrates and activation of ERK1/2 and NF-κB. These changes persisted after 72h. While signs of intestinal toxicity were also observed 24h after administration of SpHL-CDDP, after 72h body weight and intestinal permeability of mice in this group were similar to those of mice in the control group. In comparison with the free CDDP treatment group, 72h after treatment mice in the SpHL-CDDP group showed better histological parameters, lower levels of inflammatory infiltrate with increased IL-10 and IgA levels, and less activation of caspase-3, ERK1/2 and NF-κB. These differences could account for the recovery of the intestinal epithelium observed in mice treated with SpHL-CDDP but not in mice treated with free CDDP. In conclusion, here we show that encapsulation of CDDP in SpHL lessens intestinal damage and that, as such, SpHL-CDDP is a promising candidate for clinical use. Copyright © 2017. Published by Elsevier B.V.

Intestinal, extra-intestinal and systemic sequelae of Toxoplasma gondii induced acute ileitis in mice harboring a human gut microbiota

PubMed Central

von Klitzing, Eliane; Ekmekciu, Ira; Kühl, Anja A.; Bereswill, Stefan

2017-01-01

Background Within seven days following peroral high dose infection with Toxoplasma gondii susceptible conventionally colonized mice develop acute ileitis due to an underlying T helper cell (Th) -1 type immunopathology. We here addressed whether mice harboring a human intestinal microbiota developed intestinal, extra-intestinal and systemic sequelae upon ileitis induction. Methodology/Principal findings Secondary abiotic mice were generated by broad-spectrum antibiotic treatment and associated with a complex human intestinal microbiota following peroral fecal microbiota transplantation. Within three weeks the human microbiota had stably established in the murine intestinal tract as assessed by quantitative cultural and culture-independent (i.e. molecular 16S rRNA based) methods. At day 7 post infection (p.i.) with 50 cysts of T. gondii strain ME49 by gavage human microbiota associated (hma) mice displayed severe clinical, macroscopic and microscopic sequelae indicating acute ileitis. In diseased hma mice increased numbers of innate and adaptive immune cells within the ileal mucosa and lamina propria and elevated intestinal secretion of pro-inflammatory mediators including IFN-γ, IL-12 and nitric oxide could be observed at day 7 p.i. Ileitis development was accompanied by substantial shifts in intestinal microbiota composition of hma mice characterized by elevated total bacterial loads and increased numbers of intestinal Gram-negative commensals such as enterobacteria and Bacteroides / Prevotella species overgrowing the small and large intestinal lumen. Furthermore, viable bacteria translocated from the inflamed ileum to extra-intestinal including systemic compartments. Notably, pro-inflammatory immune responses were not restricted to the intestinal tract as indicated by increased pro-inflammatory cytokine secretion in extra-intestinal (i.e. liver and kidney) and systemic compartments including spleen and serum. Conclusion/Significance With respect to the intestinal

Intestinal, extra-intestinal and systemic sequelae of Toxoplasma gondii induced acute ileitis in mice harboring a human gut microbiota.

PubMed

von Klitzing, Eliane; Ekmekciu, Ira; Kühl, Anja A; Bereswill, Stefan; Heimesaat, Markus M

2017-01-01

Within seven days following peroral high dose infection with Toxoplasma gondii susceptible conventionally colonized mice develop acute ileitis due to an underlying T helper cell (Th) -1 type immunopathology. We here addressed whether mice harboring a human intestinal microbiota developed intestinal, extra-intestinal and systemic sequelae upon ileitis induction. Secondary abiotic mice were generated by broad-spectrum antibiotic treatment and associated with a complex human intestinal microbiota following peroral fecal microbiota transplantation. Within three weeks the human microbiota had stably established in the murine intestinal tract as assessed by quantitative cultural and culture-independent (i.e. molecular 16S rRNA based) methods. At day 7 post infection (p.i.) with 50 cysts of T. gondii strain ME49 by gavage human microbiota associated (hma) mice displayed severe clinical, macroscopic and microscopic sequelae indicating acute ileitis. In diseased hma mice increased numbers of innate and adaptive immune cells within the ileal mucosa and lamina propria and elevated intestinal secretion of pro-inflammatory mediators including IFN-γ, IL-12 and nitric oxide could be observed at day 7 p.i. Ileitis development was accompanied by substantial shifts in intestinal microbiota composition of hma mice characterized by elevated total bacterial loads and increased numbers of intestinal Gram-negative commensals such as enterobacteria and Bacteroides / Prevotella species overgrowing the small and large intestinal lumen. Furthermore, viable bacteria translocated from the inflamed ileum to extra-intestinal including systemic compartments. Notably, pro-inflammatory immune responses were not restricted to the intestinal tract as indicated by increased pro-inflammatory cytokine secretion in extra-intestinal (i.e. liver and kidney) and systemic compartments including spleen and serum. With respect to the intestinal microbiota composition "humanized" mice display acute ileitis

The prevalence of binge drinking among primary care residents.

PubMed

Greene, Magdalena; Johnson, J Aaron; Seale, J Paul; Tindol, Allen; Le, Kristy B; Clemow, Diana D; Barham, Ann H; Miller, David P

2017-01-01

Over one quarter of American adults binge drink, resulting in significant alcohol-related morbidity and mortality. Although brief interventions can decrease patients' alcohol use, many physicians in training do not provide this service. This study examines the prevalence of binge drinking among primary care residents, and the association of resident drinking behaviors with addressing patients' hazardous alcohol use. Between July 2013 and August 2014, the authors surveyed all trainees in 6 primary care residency programs. The survey assessed self-reported frequency of binge drinking, confidence working with hazardous drinkers, and the performance of brief interventions when hazardous drinking was detected in patients. 221 of 246 residents completed the survey (response rate 89.8%). Half of residents (109/221) reported at least one episode of binge drinking in the prior year, and 18% (39/221) reported binge drinking at least once a month. In multivariable analysis, monthly binge drinking was associated with male gender (OR 2.5, 95% CI 1.1-5.4) and year of training (OR 0.25 for Year 3 vs. Year 1, 95% CI 0.07-0.90). Few residents felt confident they could help patients cut down or quit alcohol, regardless of personal binge drinking history (19% for those who binged monthly, 24% for those who binged 1-11 times a year, and 27% for those who never binged, p for trend = 0.31). Performance of brief interventions did not vary by personal binge drinking history. Binge drinking is common among primary care residents. In addition to training residents to effectively intervene with hazardous drinkers, residency programs should address the high prevalence of binge drinking by their physicians in training.

An evaluation of hernia education in surgical residency programs.

PubMed

Hope, W W; O'Dwyer, B; Adams, A; Hooks, W B; Kotwall, C A; Clancy, T V

2014-08-01

The purpose of this study was to evaluate surgical residents' educational experience related to ventral hernias. A 16-question survey was sent to all program coordinators to distribute to their residents. Consent was obtained following a short introduction of the purpose of the survey. Comparisons based on training level were made using χ(2) test of independence, Fisher's exact, and Fisher's exact with Monte Carlo estimate as appropriate. A p value <0.05 was considered significant. The survey was returned by 183 residents from 250 surgical programs. Resident postgraduate year (PG-Y) level was equivalent among groups. Preferred techniques for open ventral hernia varied; the most common (32 %) was intra-abdominal placement of mesh with defect closure. Twenty-two percent of residents had not heard of the retrorectus technique for hernia repair, 48 % had not performed the operation, and 60 % were somewhat comfortable with and knew the general categories of mesh prosthetics products. Mesh choices, biologic and synthetic, varied among the different products. The most common type of hernia education was teaching in the operating room in 87 %, didactic lecture 69 %, and discussion at journal club 45 %. Number of procedures, comfort level with open and laparoscopic techniques, indications for mesh use and technique, familiarity and use of retrorectus repair, and type of hernia education varied significantly based on resident level (p < 0.05). Exposure to hernia techniques and mesh prosthetics in surgical residency programs appears to vary. Further evaluation is needed and may help in standardizing curriculums for hernia repair for surgical residents.

Oncology house physician model: a response to changes in pediatric resident coverage.

PubMed

Rapson, Alicia; Kersun, Leslie

2014-10-01

Given decreasing resident duty hours, subspecialty hospitalist models have emerged to help compensate for the restructured presence of residents. We sought to examine the impact of our pediatric oncology hospitalist model on the oncology unit staff. The survey was developed after a literature review of subspecialty hospitalist models. The final surveys were designed using a 5-point Likert scale. Descriptive statistics were used to compile baseline demographic characteristics of respondents and overall responses to survey questions. Respondents agreed that house physicians provide better continuity of care (96.8%), are more comfortable with the experience level of the physician (98.4%), and are better able to answer questions (92%). Respondents also agreed that house physicians serve as backup for system-related and patient-related questions and found security knowing an experienced provider was on the floor (87.5%). Responses to open-ended questions indicated that the house physician model has impacted fellow education. Our oncology house physician model helps account for decreased residency duty hours. This can serve as a model for other institutions requiring subspecialty inpatient coverage, given resident work hour restrictions. Adjustments in the clinical education of hematology/oncology fellows need to be considered in the setting of competent, consistent, and experienced front-line providers.

A collaborative approach to residency preparation programming for pharmacy students.

PubMed

Rider, Shyla K; Oeder, Jessica L; Nguyen, Trang T; Rodis, Jennifer L

2014-06-01

An innovative program to help pharmacy students navigate the residency application and interview process is described, including results of a survey evaluating the program's impact. The Ohio State University (OSU) chapter of the Student Society of Health-System Pharmacy (SSHP) collaborated with OSU College of Pharmacy faculty members, pharmacists from OSU Wexner Medical Center and surrounding areas, and current pharmacy residents to provide programming to equip pharmacy students with skills to succeed as residency candidates. The programming has four components: Curriculum Vitae (CV) Critique, Mock Residency Interviews, Residency 101, and Midyear to Match (M-M), a six-part series that provides guidance on the Residency Showcase at the American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting, Match day (the annual matching process coordinated by ASHP), and the post-Match "scramble," in which unmatched applicants compete for unfilled residency slots. In an online survey conducted by the SSHP chapter after the 2012-13 residency year, 26 of 57 survey respondents indicated they had pursued a residency. Twenty respondents reported success in the Match (a rate 15% higher than the national average), with 9 reporting acceptance by their first-choice residency site. The mock interview program was rated as the most useful (a mean score of 4.8 on a 5-point scale), followed by the M-M series (mean score, 4.6). Collaborative programming coordinated by the OSU chapter of SSHP was offered to pharmacy students to improve preparation for the residency application and interview process. The program was well received by participants. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Survey of Residents' Attitudes and Awareness Toward Teaching and Student Feedback

PubMed Central

Tuck, Keiran K.; Murchison, Charles; Flores, Christine; Kraakevik, Jeff

2014-01-01

Background Teaching medical students is an important component of residency; however, little is known about student feedback regarding resident teaching skills. Objective We sought to explore resident awareness of medical student feedback mechanisms and how feedback is obtained, and also identified attitudes about teaching more commonly found in residents who seek feedback. Methods We surveyed all resident physicians at a university-affiliated academic health center about awareness of student feedback regarding their teaching abilities, and their attitudes related to teaching that may impact whether residents seek feedback. Results Of 605 residents, 335 (55%) responded, with 72% (242 of 335) noting they did not formally review student feedback of their teaching with their advisor during regularly scheduled meetings, 42% (140 of 332) reporting they did not know of any formal feedback mechanisms, and 28.4% (95 of 334) reporting they had not received feedback from students in any format. Although only a quarter of residents solicit feedback always or often, more than half would like feedback always or often. Reported barriers to feedback included student apprehension, time constraints, and lack of a formal system. A majority of residents had positive attitudes toward teaching and felt that student feedback would help teaching ability and medical proficiency. Conclusions A large percentage of residents at 1 teaching institution reported not receiving feedback from students on their teaching abilities. Residents who did receive feedback were more likely to have actively solicited it. Overall, residents believe that this feedback from students would benefit their clinical and teaching performance. PMID:26140121

The effect of fucoidan on intestinal flora and intestinal barrier function in rats with breast cancer.

PubMed

Xue, Meilan; Ji, Xinqiang; Liang, Hui; Liu, Ying; Wang, Bing; Sun, Lingling; Li, Weiwei

2018-02-21

Recent research studies have shown that the intestinal flora are related to the occurrence and progress of breast cancer. This study investigates the effect of fucoidan on intestinal flora and intestinal barrier function in rats with 7,12-dimethylbenz[a]anthracene (DMBA)-induced breast cancers. Sixty female Sprague-Dawley rats were randomly assigned to the control group, the model group, and the F1 and F2 groups, which were fed fucoidan at concentrations of 200 and 400 mg per kg bw (body weight), respectively. Intestinal histopathological analysis was performed and 16S rDNA high-throughput sequencing was used to provide an overview of the intestinal flora composition. The contents of d-lactic acid (d-LA), diamine oxidase (DAO) and endotoxin in plasma were detected by ELISA. Expression levels of the tight junction (TJ) proteins, phosphorylated p38 MAPK and ERK1/2 were measured using western blotting. Our results suggested that the intestinal wall of the model group was damaged. However, after fucoidan intervention, the villi were gradually restored. ELISA showed that the levels of plasma endotoxin, d-LA and DAO decreased in the F1 and F2 groups compared to those in the model group. Fucoidan treatment also increased the expressions of ZO-1, occludin, claudin-1 and claudin-8. Furthermore, the expression levels of phosphorylated p38 MAPK and ERK1/2 were upregulated in fucoidan treatment groups. The results of 16S rDNA high-throughput sequencing indicated that fucoidan increased the diversity of the intestinal microbiota and induced changes in microbial composition, with the increased Bacteroidetes/Firmicutes phylum ratio. In conclusion, the supplement of fucoidan could improve the fecal microbiota composition and repair the intestinal barrier function. The study suggested the use of fucoidan as an intestinal flora modulator for potential prevention of breast cancer.

Role of Pharmacy Residency Training in Career Planning: A Student’s Perspective

PubMed Central

McElhaney, Ashley; Weber, Robert J.

2014-01-01

Pharmacy students typically become more focused on career planning and assessment in the final year of their PharmD training. Weighing career options in the advanced pharmacy practice experience year can be both exciting and stressful. The goal of this article is to provide a primer on how pharmacy students can assess how a residency can fit into career planning. This article will describe the various career paths available to graduating students, highlight ways in which a residency can complement career choices, review the current state of the job market for pharmacists, discuss the current and future plans for residency programs, and present thoughts from some current and former residents on why they chose to complete a residency. Most career paths require some additional training, and a residency provides appropriate experience very quickly compared to on-the-job training. Alternative plans to residency training must also be considered, as there are not enough residency positions for candidates. Directors of pharmacy must consider several factors when giving career advice on pharmacy residency training to pharmacy students; they should provide the students with an honest assessment of their work skills and their abilities to successfully complete a residency. This assessment will help the students to set a plan for improvement and give them a better chance at being matched to a pharmacy residency. PMID:25673897

[Morphological changes of the intestine in experimental acute intestinal infection in the treatment of colloidal silver].

PubMed

Polov'ian, E S; Chemich, N D; Moskalenko, R A; Romaniuk, A N

2012-06-01

At the present stage of infectionist practice in the treatment of acute intestinal infections caused by opportunistic microorganisms, colloidal silver is used with a particle size of 25 nm as an alternative to conventional causal therapy. In 32 rats, distributed in 4 groups of 8 animals each (intact; healthy, got colloidal silver; with a modeled acute intestinal infection in the basic treatment and with the addition of colloidal silver), histological examination was performed of small and large intestine of rats. Oral administration of colloidal silver at a dose of 0.02 mg/day to intact rats did not lead to changes in morphometric parameters compared to the norm, and during early convalescence in rats with acute intestinal infections were observed destructive and compensatory changes in the intestine, which depended on the treatment regimen. With the introduction of colloidal silver decreased activity of the inflammatory process and the severity of morphological changes in tissues of small and large intestine, indicating that the positive effect of study drug compared with baseline therapy.

Parenteral Nutrition and Intestinal Failure

PubMed Central

Bielawska, Barbara; Allard, Johane P.

2017-01-01

Severe short bowel syndrome (SBS) is a major cause of chronic (Type 3) intestinal failure (IF) where structural and functional changes contribute to malabsorption and risk of micronutrient deficiencies. Chronic IF may be reversible, depending on anatomy and intestinal adaptation, but most patients require long-term nutritional support, generally in the form of parenteral nutrition (PN). SBS management begins with dietary changes and pharmacologic therapies taking into account individual anatomy and physiology, but these are rarely sufficient to avoid PN. New hormonal therapies targeting intestinal adaptation hold promise. Surgical options for SBS including intestinal transplant are available, but have significant limitations. Home PN (HPN) is therefore the mainstay of treatment for severe SBS. HPN involves chronic administration of macronutrients, micronutrients, fluid, and electrolytes via central venous access in the patient’s home. HPN requires careful clinical and biochemical monitoring. Main complications of HPN are related to venous access (infection, thrombosis) and metabolic complications including intestinal failure associated liver disease (IFALD). Although HPN significantly impacts quality of life, outcomes are generally good and survival is mostly determined by the underlying disease. As chronic intestinal failure is a rare disease, registries are a promising strategy for studying HPN patients to improve outcomes. PMID:28481229

Microbiomes Have the Power to Help or Hinder Your Health

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jansson, Janet

They are everywhere: countless microorganisms that inhabit our world—even in your skin, mouth, gut and other parts of your body. Called microbiomes, these communities play a fundamental role in our ecosystem and our bodies, influencing everything from climate to human health. And scientists at PNNL are studying microbiomes to better understand how they influence our daily lives. Scientist Janet Jansson studies complex microbiomes in soil and the human intestine to understand changes in the composition or function of microbes. In the soil, these microbes are associated with carbon cycling and degrading pollutants, as well as plant health. In the intestine,more » they are responsible for digestion of our food and protection from pathogens. When they go awry, they can be associated with numerous inflammatory bowel diseases, such as Crohn’s. Understanding the factors underlying these microbiome changes will ultimately help researchers develop solutions to problems encountered within our world and our bodies.« less

Epithelial stem cells and intestinal cancer.

PubMed

Tan, Shawna; Barker, Nick

2015-06-01

The mammalian intestine is comprised of an epithelial layer that serves multiple functions in order to maintain digestive activity as well as intestinal homeostasis. This epithelial layer contains highly proliferative stem cells which facilitate its characteristic rapid regeneration. How these stem cells contribute to tissue repair and normal homeostasis are actively studied, and while we have a greater understanding of the molecular mechanisms and cellular locations that underlie stem cell regulation in this tissue, much still remains undiscovered. This review describes epithelial stem cells in both intestinal and non-intestinal tissues, as well as the strategies that have been used to further characterize the cells. Through a discussion of the current understanding of intestinal self-renewal and tissue regeneration in response to injury, we focus on how dysregulation of critical signaling pathways results in potentially oncogenic aberrations, and highlight issues that should be addressed in order for effective intestinal cancer therapies to be devised. Copyright © 2014 Elsevier Ltd. All rights reserved.

Identification of astilbin metabolites produced by human intestinal bacteria using UPLC-Q-TOF/MS.

PubMed

Zhao, Min; Xu, Jun; Qian, Dawei; Guo, Jianming; Jiang, Shu; Shang, Er-xin; Duan, Jin-ao

2014-07-01

Astilbin, mainly isolated from a commonly used herbal medicine, Smilax glabra Roxb (SGR), exhibits a variety of pharmacological activities and biological effects. It is metabolized by intestinal bacteria after oral administration which leads to the variation of ethnopharmacological profile of this traditional medicine. However, little is known on the interactions of this active compound with intestinal bacteria, which would be very helpful in unravelling how SGR works. In this study, different pure bacteria from human feces were isolated and were used to investigate their conversion capability of astilbin. Ultra-performance liquid chromatography/quadrupole-time-of-flight mass spectrometry (UPLC-Q-TOF/MS) technique combined with Metabolynx(TM) software was used to analyze astilbin and its metabolites. The parent compound and two metabolites (quercetin and eriodictyol) were detected in the isolated bacterial samples compared with blank samples. Quercetin was present in Enterococcus sp. 8B, 8-2 and 9-2 samples. Eriodictyol was only identified in Enterococcus sp. 8B sample. The metabolic routes and metabolites of astilbin produced by the different intestinal bacteria are reported for the first time. This will be useful for the investigation of the pharmacokinetic study of astilbin in vivo and the role of different intestinal bacteria in the metabolism of natural compounds. Copyright © 2014 John Wiley & Sons, Ltd.

Factors associated with interest in subspecialty training among neurology residents.

PubMed

Teixeira-Poit, Stephanie M; Halpern, Michael T; Kane, Heather L; Frost, A Corey; Keating, Michael; Olmsted, Murrey

2015-01-01

PHENOMENON: Previous studies have not explored factors associated with decisions among neurology residents to pursue subspecialty training within neurology. Understanding career choices among neurology residents, particularly decisions regarding subspecialty training, is critical, as neurologists with specialized knowledge can help meet the needs of patients with specific disease conditions. This study addresses the knowledge gap about subspecialty training decisions by examining factors associated with neurology residents' interest in pursuing subspecialty training and the types of subspecialty training neurology residents consider. We surveyed a geographically stratified sample of neurology residents in U.S. training programs using a two-stage survey design. In Stage 1, we randomly sampled half of the accredited neurology residency programs stratified by U.S. census region; Stage 2 involved a survey of neurology residents within these programs. The majority (approximately 81%) of residents expressed interest in subspecialty training. Resident demographic characteristics and educational debt did not influence interest in pursuing subspecialty training. Residents were more likely to express interest in subspecialty training when they participated in any neurology research (odds ratio [OR] = 2.39), 95% confidence interval (CI) [1.13, 5.07], p = .02, and indicated more interest in careers involving teaching (OR = 8.33), 95% CI [1.64, 42.19], p = .01. Considering the "medical content of subspecialty" as a more important factor approached but did not reach statistical significance (OR = 3.12), 95% CI [0.97, 10.06], p = .06. Insights: Participation in any neurology research and interest in careers involving teaching are associated with interest in subspecialty training among neurology residents. Further research is needed to determine whether exposure to research and teaching stimulates interest in subspecialty training and whether residents believe that subspecialty

[Intrauterine intestinal volvulus].

PubMed

Gawrych, Elzbieta; Chojnacka, Hanna; Wegrzynowski, Jerzy; Rajewska, Justyna

2009-07-01

Intrauterine intestinal volvulus is an extremely rare case of acute congenital intestinal obstruction. The diagnosis is usually possible in the third trimester of a pregnancy. Fetal midgut volvulus is most likely to be recognized by observing a typical clockwise whirlpool sign during color Doppler investigation. Multiple dilated intestinal loops with fluid levels are usually visible during the antenatal ultrasound as well. Physical and radiographic findings in the newborn indicate intestinal obstruction and an emergency surgery is required. The authors describe intrauterine volvulus in 3 female newborns in which surgical treatment was individualized. The decision about primary or delayed anastomosis after resection of the gangrenous part of the small bowel was made at the time of the surgery and depended on the general condition of the newborn, as well as presence or absence of meconium peritonitis. Double loop jejunostomy was performed in case of two newborns, followed by a delayed end-to-end anastomosis. In case of the third newborn, good blood supply of the small intestine after untwisting and 0.25% lignocaine injections into mesentery led to the assumption that the torsion was not complete and ischemia was reversible. In the two cases of incomplete rotation the cecum was sutured to the left abdominal wall to prevent further twisting. The postoperative course was uneventful and oral alimentation caused no problems. Physical development of all these children has been normal (current age: 1-2 years) and the parents have not observed any disorders or problems regarding passage of food through the alimentary canal. Prompt antenatal diagnosis of this surgical emergency and adequate choice of intervention may greatly reduce mortality due to intrauterine volvulus.

INTESTINAL PARASITES IN DIABETIC PATIENTS IN SOHAG UNIVERSITY HOSPITALS, EGYPT.

PubMed

Elnadi, Nada A; Hassanien, Hassan A; Ahmad, Amal M; Abd Ellah, Asmaa K

2015-08-01

Intestinal parasites usually create benign diseases, though they may induce complications with high morbidity and mortality to the immunocompromised, including diabetic patients. The study detected the prevalence of intestinal parasitic infections in diabetic patients, comparing to non-diabetic controls and other parameters. A total of 100 fecal samples were collected from diabetic patients at the outpatient clinic of Sohag University Hospitals and another 100 from cross matched controls. The samples were examined macroscopically and microscopically by direct smear and different concentration methods then stained by Modified Ziehl-Neelsen Acid fast stain. Glycated hemoglobin (Hb Alc) was measured to detect DM controlled patients. The data were organized, tabulated, and statistically analyzed. Intestinal parasites were found in 25 (25%) cases out of 100 patients in diabetic group and 7(7%) cases out of 100 controls with high significance (P<0.001)). In the diabetic group, Giardia lamblia was detected in 22 cases (22%) and 5 (5%) among controls, Entamoeba histolytica in 7 cases (7%) and 3 (3%) among controls, Hymenolypis nana in 5 cases (5%) and 3 (3%) among controls, Entamoeba coli in 8 patients (8%), Entamoeba hartmanni in 3 cases (3%), Dientamoeba fragilis in a case (1%), Cryptosporidium parvum in 5 cases (5%) and microsporidia in 3 cases (3%). But, E. coli, E. hartmanni, D. fragilis and C. parvum nor microsporidia were detected in controls. The rate of G. lamblia in DM patients compared to controls was high significant (P<0.001). Hymenolepis nana was 5% (5 cases) in diabetic patients compared to 3% (3 cases) in controls. Residence and sex differences were not significant, while age, >10 years showed the highest prevalence (P< 0.003), type I infection rate was significantly higher than type II (P<0.001). DM control was also significantly affected the infection rates (P<0.007 in type I and P< 0.01 in type II).

The Cost and Burden of the Residency Match in Emergency Medicine.

PubMed

Blackshaw, Aaron M; Watson, Simon C; Bush, Jeffrey S

2017-01-01

To obtain a residency match, medical students entering emergency medicine (EM) must complete away rotations, submit a number of lengthy applications, and travel to multiple programs to interview. The expenses incurred acquiring this residency position are burdensome, but there is little specialty-specific data estimating it. We sought to quantify the actual cost spent by medical students applying to EM residency programs by surveying students as they attended a residency interview. Researchers created a 16-item survey, which asked about the time and monetary costs associated with the entire EM residency application process. Applicants chosen to interview for an EM residency position at our institution were invited to complete the survey during their interview day. In total, 66 out of a possible 81 residency applicants (an 81% response rate) completed our survey. The "average applicant" who interviewed at our residency program for the 2015-16 cycle completed 1.6 away, or "audition," rotations, each costing an average of $1,065 to complete. This "average applicant" applied to 42.8 programs, and then attended 13.7 interviews. The cost of interviewing at our program averaged $342 and in total , an average of $8,312 would be spent in the pursuit of an EM residency. Due to multiple factors, the costs of securing an EM residency spot can be expensive. By understanding the components that are driving this trend, we hope that the academic EM community can explore avenues to help curtail these costs.

Captopril and the intestinal response to hemorrhagic shock.

PubMed

Rosenfeld, L M; Cooper, H S

1982-09-01

In order to help clarify the role of the renin-angiotensin system in the evolution of the post-hemorrhagic circulatory shock syndrome, captopril, a potent inhibitor of the conversion of angiotensin I to angiotensin II, was infused into a hemorrhagic shock model in the cat. The hemorrhage protocol had arterial blood withdrawn until a mean arterial blood pressure (MABP) of 40 mm Hg developed. Oligemia was maintained for a period of 2.5 hr, after which time, all remaining shed blood was reinfused and the cats observed for an additional 2 hr. Coincident with the large reduction in MABP, superior mesenteric artery flow (SMAF) was similarly reduced as recorded by a noncannulating electromagnetic flow probe fitted around the artery. Post-oligemic plasma activities of cathepsin D (CD) and alkaline phosphatase (AP) were elevated 11-fold and 3-fold respectively; intestinal morphological damage was graded at 2.8 +/- 0.6 on a 0-4 scale of increasing severity (control: 0.03 +/- 0.02). Captopril was administered at an initial priming dose of 0.5 mg/kg followed by a continuous infusion of 0.5 mg/kg/hr. Improved post-reinfusion maintenance of MABP and SMAF was noted. Plasma elevations in enzyme activity were more moderate: 8-fold for CD, 1.5-fold for AP. Intestinal morphologic damage was graded at 2.5 +/- 0.3. Blockade of angiotensin II formation by captopril thus demonstrated beneficial effects on post-oligemic hemodynamic status and on the degree of cellular enzyme release without significant improvement in intestinal morphology.

The Effect of Gender on Resident Autonomy in the Operating room.

PubMed

Meyerson, Shari L; Sternbach, Joel M; Zwischenberger, Joseph B; Bender, Edward M

Discrimination against women training in medicine and surgery has been subjectively described for decades. This study objectively documents gender differences in the degree of autonomy given to thoracic surgery trainees in the operating room. Thoracic surgery residents and faculty underwent frame of reference training on the use of the 4-point Zwisch scale to measure operative autonomy. Residents and faculty then submitted evaluations of their perception of autonomy granted for individual operations as well as operative difficulty on a real-time basis using the "Zwisch Me!!" mobile application. Differences in autonomy given to male and female residents were elucidated using chi-square analysis and ordered logistic regression. Seven academic medical centers with thoracic surgery training programs. Volunteer thoracic surgery residents in both integrated and traditional training pathways and their affiliated cardiothoracic faculty. Residents (n = 33, female 18%) submitted a total of 596 evaluations to faculty (n = 48, female 12%). Faculty gave less autonomy to female residents with only 56 of 184 evaluations (30.3%) showing meaningful autonomy (passive help or supervision only) compared to 107 of 292 evaluations (36.7%) at those levels for male residents (p = 0.02). Resident perceptions of autonomy showed even more pronounced differences with female residents receiving only 38 of 197 evaluations (19.3%) with meaningful autonomy compared to 133 of 399 evaluations (33.3%) for male residents (p < 0.001). Potential influencing factors explored included attending gender and specialty, case type and difficulty, and resident level of training. In multivariate analysis, only case difficultly, resident gender, and level of training were significantly related to autonomy granted to residents. Evaluations of operative autonomy reveal a significant bias against female residents. Faculty education is needed to encourage allowing female residents more operative autonomy. Copyright

Impact of Residency Training Redesign on Residents' Clinical Knowledge.

PubMed

Waller, Elaine; Eiff, M Patrice; Dexter, Eve; Rinaldo, Jason C B; Marino, Miguel; Garvin, Roger; Douglass, Alan B; Phillips, Robert; Green, Larry A; Carney, Patricia A

2017-10-01

The In-training Examination (ITE) is a frequently used method to evaluate family medicine residents' clinical knowledge. We compared family medicine ITE scores among residents who trained in the 14 programs that participated in the Preparing the Personal Physician for Practice (P4) Project to national averages over time, and according to educational innovations. The ITE scores of 802 consenting P4 residents who trained in 2007 through 2011 were obtained from the American Board of Family Medicine. The primary analysis involved comparing scores within each academic year (2007 through 2011), according to program year (PGY) for P4 residents to all residents nationally. A secondary analysis compared ITE scores among residents in programs that experimented with length of training and compared scores among residents in programs that offered individualized education options with those that did not. Release of ITE scores was consented to by 95.5% of residents for this study. Scores of P4 residents were higher compared to national scores in each year. For example, in 2011, the mean P4 score for PGY1 was 401.2, compared to the national average of 386. For PGY2, the mean P4 score was 443.1, compared to the national average of 427, and for PGY3, the mean P4 score was 477.0, compared to the national PGY3 score of 456. Scores of residents in programs that experimented with length of training were similar to those in programs that did not. Scores were also similar between residents in programs with and without individualized education options. Family medicine residency programs undergoing substantial educational changes, including experiments in length of training and individualized education, did not appear to experience a negative effect on resident's clinical knowledge, as measured by ITE scores. Further research is needed to study the effect of a wide range of residency training innovations on ITE scores over time.

An Analysis of Publication Productivity During Residency for 1506 Neurosurgical Residents and 117 Residency Departments in North America.

PubMed

Khan, Nickalus R; Saad, Hassan; Oravec, Chesney S; Norrdahl, Sebastian P; Fraser, Brittany; Wallace, David; Lillard, Jock C; Motiwala, Mustafa; Nguyen, Vincent N; Lee, Siang Liao; Jones, Anna V; Ajmera, Sonia; Kalakoti, Piyush; Dave, Pooja; Moore, Kenneth A; Akinduro, Olutomi; Nyenwe, Emmanuel; Vaughn, Brandy; Michael, L Madison; Klimo, Paul

2018-05-30

Bibliometrics is defined as the study of statistical and mathematical methods used to quantitatively analyze scientific literature. The application of bibliometrics in neurosurgery continues to evolve. To calculate a number of publication productivity measures for almost all neurosurgical residents and departments within North America. These measures were correlated with survey results on the educational environment within residency programs. During May to June 2017, data were collected from departmental websites and Scopus to compose a bibliometric database of neurosurgical residents and residency programs. Data related to authorship value and study content were collected on all articles published by residents. A survey of residency program research and educational environment was administered to program directors and coordinators; results were compared with resident academic productivity. The median number of publications in residency was 3; median h-index and Resident index were 1 and 0.17 during residency, respectively. There was a statistically significant difference in academic productivity among male neurosurgical residents compared with females. The majority of articles published were tier 1 clinical articles. Residency program research support was significantly associated with increased resident productivity (P < .001). Scholarly activity requirements were not associated with increased resident academic productivity. This study represents the most comprehensive bibliometric assessment of neurosurgical resident academic productivity during training to date. New benchmarks for individual and department academic productivity are provided. A supportive research environment for neurosurgical residents is associated with increased academic productivity, but a scholarly activity requirement was, surprisingly, not shown to have a positive effect.

Competency-based achievement system: using formative feedback to teach and assess family medicine residents' skills.

PubMed

Ross, Shelley; Poth, Cheryl N; Donoff, Michel; Humphries, Paul; Steiner, Ivan; Schipper, Shirley; Janke, Fred; Nichols, Darren

2011-09-01

Family medicine residency programs require innovative means to assess residents' competence in "soft" skills (eg, patient-centred care, communication, and professionalism) and to identify residents who are having difficulty early enough in their residency to provide remedial training. To develop a method to assess residents' competence in various skills and to identify residents who are having difficulty. The Competency-Based Achievement System (CBAS) was designed to measure competence using 3 main principles: formative feedback, guided self-assessment, and regular face-to-face meetings. The CBAS is resident driven and provides a framework for meaningful interactions between residents and advisors. Residents use the CBAS to organize and review their feedback, to guide their own assessment of their progress, and to discern their future learning needs. Advisors use the CBAS to monitor, guide, and verify residents' knowledge of and competence in important skills. By focusing on specific skills and behaviour, the CBAS enables residents and advisors to make formative assessments and to communicate their findings. Feedback indicates that the CBAS is a user-friendly and helpful system to assess competence.

Intestinal adaptations in chronic kidney disease and the influence of gastric bypass surgery.

PubMed

Hatch, Marguerite

2014-09-01

Studies have shown that compensatory adaptations in gastrointestinal oxalate transport can impact the amount of oxalate excreted by the kidney. Hyperoxaluria is a major risk factor in the formation of kidney stones, and oxalate is derived from both the diet and the liver metabolism of glyoxylate. Although the intestine generally absorbs oxalate from dietary sources and can contribute as much as 50% of urinary oxalate, enteric oxalate elimination plays a significant role when renal function is compromised. While the mechanistic basis for these changes in the direction of intestinal oxalate movements in chronic renal failure involves an upregulation of angiotensin II receptors in the large intestine, enteric secretion/excretion of oxalate can also occur by mechanisms that are independent of angiotensin II. Most notably, the commensal bacterium Oxalobacter sp. interacts with the host enterocyte and promotes the movement of oxalate from the blood into the lumen, resulting in the beneficial effect of significantly lowering urinary oxalate excretion. Changes in the passive permeability of the intestine, such as in steatorrhoea and following gastric bypass, also promote oxalate absorption and hyperoxaluria. In summary, this report highlights the two-way physiological signalling between the gut and the kidney, which may help to alleviate the consequences of certain kidney diseases. © 2014 The Author. Experimental Physiology © 2014 The Physiological Society.

Intestinal Rehabilitation Programs in the Management of Pediatric Intestinal Failure and Short Bowel Syndrome.

PubMed

Merritt, Russell J; Cohran, Valeria; Raphael, Bram P; Sentongo, Timothy; Volpert, Diana; Warner, Brad W; Goday, Praveen S

2017-11-01

Intestinal failure is a rare, debilitating condition that presents both acute and chronic medical management challenges. The condition is incompatible with life in the absence of the safe application of specialized and individualized medical therapy that includes surgery, medical equipment, nutritional products, and standard nursing care. Intestinal rehabilitation programs are best suited to provide such complex care with the goal of achieving enteral autonomy and oral feeding with or without intestinal transplantation. These programs almost all include pediatric surgeons, pediatric gastroenterologists, specialized nurses, and dietitians; many also include a variety of other medical and allied medical specialists. Intestinal rehabilitation programs provide integrated interdisciplinary care, more discussion of patient management by involved specialists, continuity of care through various treatment interventions, close follow-up of outpatients, improved patient and family education, earlier treatment of complications, and learning from the accumulated patient databases. Quality assurance and research collaboration among centers are also goals of many of these programs. The combined and coordinated talents and skills of multiple types of health care practitioners have the potential to ameliorate the impact of intestinal failure and improve health outcomes and quality of life.

Curriculum on Resident Education in Care of Older Adults in Acute, Transitional and Extended Care Settings

ERIC Educational Resources Information Center

Kumar, Chandrika; Bensadon, Benjamin A.; Van Ness, Peter H.; Cooney, Leo M.

2016-01-01

Most geriatric care is provided in non-hospital settings. Internal Medicine and Family Medicine residents should therefore learn about these different clinical sites and acuity levels of care. To help facilitate this learning, a geriatrics training curriculum for internal medicine residents was developed that focused on cognition, function, goals…

Ultrasonographic features of intestinal entrapment in dogs.

PubMed

Swift, Inar

2009-01-01

The clinical and ultrasonographic features of postoperative intestinal entrapment were assessed in five dogs. Four had vomiting and lethargy, and one had peracute collapse and hematochezia. Ultrasonographic findings in four of five dogs were similar, being characterized by focally hyperechoic mesentery and abdominal effusion, surrounding a single loop of amotile and dilated intestine. In some dogs, the affected intestinal loop had a thickened or corrugated wall, or alteration of wall layering. In one dog, the site of entrapment could be directly visualized. In the most severely affected dog, a large volume of echogenic peritoneal effusion was present, as well as fluid dilation of multiple intestinal loops. The ultrasonographic appearance of intestinal entrapment is similar to that of intestinal perforation or infarction by other causes.

Thyroid hormone regulation of adult intestinal stem cells: Implications on intestinal development and homeostasis.

PubMed

Sun, Guihong; Roediger, Julia; Shi, Yun-Bo

2016-12-01

Organ-specific adult stem cells are essential for organ homeostasis, tissue repair and regeneration. The formation of such stem cells often takes place during postembryonic development, a period around birth in mammals when plasma thyroid hormone concentration is high. The life-long self-renewal of the intestinal epithelium has made mammalian intestine a valuable model to study the function and regulation and adult stem cells. On the other hand, much less is known about how the adult intestinal stem cells are formed during vertebrate development. Here, we will review some recent progresses on this subject, focusing mainly on the formation of the adult intestine during Xenopus metamorphosis. We will discuss the role of thyroid hormone signaling pathway in the process and potential molecular conservations between amphibians and mammals as well as the implications in organ homeostasis and human diseases.

Rational design of polyarginine nanocapsules intended to help peptides overcoming intestinal barriers.

PubMed

Niu, Zhigao; Tedesco, Erik; Benetti, Federico; Mabondzo, Aloïse; Montagner, Isabella Monia; Marigo, Ilaria; Gonzalez-Touceda, David; Tovar, Sulay; Diéguez, Carlos; Santander-Ortega, Manuel J; Alonso, María J

2017-10-10

The aim of this work was to rationally design and characterize nanocapsules (NCs) composed of an oily core and a polyarginine (PARG) shell, intended for oral peptide delivery. The cationic polyaminoacid, PARG, and the oily core components were selected based on their penetration enhancing properties. Insulin was adopted as a model peptide to assess the performance of the NCs. After screening numerous formulation variables, including different oils and surfactants, we defined a composition consisting of oleic acid, sodium deoxycholate (SDC) and Span 80. This selected NCs composition, produced by the solvent displacement technique, exhibited the following key features: (i) an average size of 180nm and a low polydispersity (0.1), (ii) a high insulin association efficacy (80-90% AE), (iii) a good colloidal stability upon incubation in simulated intestinal fluids (SIF, FaSSIF-V2, FeSSIF-V2), and (iv) the capacity to control the release of the associated insulin for >4h. Furthermore, using the Caco-2 model cell line, PARG nanocapsules were able to interact with the enterocytes, and reversibly modify the TEER of the monolayer. Both cell adhesion and membrane permeabilization could account for the pronounced transport of the NCs-associated insulin (3.54%). This improved interaction was also visualized by confocal fluorescent microscopy following oral administration of PARG nanocapsulesto mice. Finally, in vivo efficacy studies performed in normoglycemic rats showed a significant decrease in their plasma glucose levels after treatment. In conclusion, here we disclose key formulation elements for making possible the oral administration of peptides. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Intestinal hormones and growth factors: Effects on the small intestine

PubMed Central

Drozdowski, Laurie; Thomson, Alan BR

2009-01-01

There are various hormones and growth factors which may modify the intestinal absorption of nutrients, and which might thereby be useful in a therapeutic setting, such as in persons with short bowel syndrome. In partI, we focus first on insulin-like growth factors, epidermal and transferring growth factors, thyroid hormones and glucocorticosteroids. Part II will detail the effects of glucagon-like peptide (GLP)-2 on intestinal absorption and adaptation, and the potential for an additive effect of GLP2 plus steroids. PMID:19152442

Animal experimental studies using small intestine endoscope

PubMed Central

Liu, Jin-Hua; Liu, Dan-Yang; Wang, Li; Han, Li-Ping; Qi, Zhe-Yu; Ren, Hai-Jun; Feng, Yan; Luan, Feng-Ming; Mi, Liang-Tian; Shan, Shu-Mei

2017-01-01

AIM To assess the feasibility and safety of a novel enteroscope, negative-pressure suction endoscope in examining the small intestine of a porcine model. METHODS In vitro experiments in small intestinal loops from 20 pigs and in vivo experiments in 20 living pigs were conducted. RESULTS In in vitro experiments, a negative pressure of > 0.06 MPa was necessary for optimal visualization of the intestine, and this pressure did not cause gross or histological damage to the mucosa. For satisfactory examination of the small intestine in vivo, higher negative pressure (> 1.00 MPa) was required. Despite this higher pressure, the small intestine did not show any gross or microscopic damage in the suctioned areas. The average time of examination in the living animals was 60 ± 7.67 min. The animals did not experience any apparent ill effects from the procedure. CONCLUSION Small intestine endoscope was safely performed within a reasonable time period and enabled complete visualization of the intestine in most cases. PMID:28611521

Incorporating resident research into the dermatology residency program.

PubMed

Wagner, Richard F; Raimer, Sharon S; Kelly, Brent C

2013-01-01

Programmatic changes for the dermatology residency program at The University of Texas Medical Branch were first introduced in 2005, with the faculty goal incorporating formal dermatology research projects into the 3-year postgraduate training period. This curriculum initially developed as a recommendation for voluntary scholarly project activity by residents, but it evolved into a program requirement for all residents in 2009. Departmental support for this activity includes assignment of a faculty mentor with similar interest about the research topic, financial support from the department for needed supplies, materials, and statistical consultation with the Office of Biostatistics for study design and data analysis, a 2-week elective that provides protected time from clinical activities for the purpose of preparing research for publication and submission to a peer-reviewed medical journal, and a departmental award in recognition for the best resident scholarly project each year. Since the inception of this program, five classes have graduated a total of 16 residents. Ten residents submitted their research studies for peer review and published their scholarly projects in seven dermatology journals through the current academic year. These articles included three prospective investigations, three surveys, one article related to dermatology education, one retrospective chart review, one case series, and one article about dermatopathology. An additional article from a 2012 graduate about dermatology education has also been submitted to a journal. This new program for residents was adapted from our historically successful Dermatology Honors Research Program for medical students at The University of Texas Medical Branch. Our experience with this academic initiative to promote dermatology research by residents is outlined. It is recommended that additional residency programs should consider adopting similar research programs to enrich resident education.

Incorporating resident research into the dermatology residency program

PubMed Central

Wagner, Richard F; Raimer, Sharon S; Kelly, Brent C

2013-01-01

Programmatic changes for the dermatology residency program at The University of Texas Medical Branch were first introduced in 2005, with the faculty goal incorporating formal dermatology research projects into the 3-year postgraduate training period. This curriculum initially developed as a recommendation for voluntary scholarly project activity by residents, but it evolved into a program requirement for all residents in 2009. Departmental support for this activity includes assignment of a faculty mentor with similar interest about the research topic, financial support from the department for needed supplies, materials, and statistical consultation with the Office of Biostatistics for study design and data analysis, a 2-week elective that provides protected time from clinical activities for the purpose of preparing research for publication and submission to a peer-reviewed medical journal, and a departmental award in recognition for the best resident scholarly project each year. Since the inception of this program, five classes have graduated a total of 16 residents. Ten residents submitted their research studies for peer review and published their scholarly projects in seven dermatology journals through the current academic year. These articles included three prospective investigations, three surveys, one article related to dermatology education, one retrospective chart review, one case series, and one article about dermatopathology. An additional article from a 2012 graduate about dermatology education has also been submitted to a journal. This new program for residents was adapted from our historically successful Dermatology Honors Research Program for medical students at The University of Texas Medical Branch. Our experience with this academic initiative to promote dermatology research by residents is outlined. It is recommended that additional residency programs should consider adopting similar research programs to enrich resident education. PMID:23901305

Learning to doctor: tinkering with visibility in residency training.

PubMed

Wallenburg, Iris; Bont, Antoinette; Heineman, Maas-Jan; Scheele, Fedde; Meurs, Pauline

2013-05-01

Medical doctors in teaching hospitals aim to serve the two central goals of patient care and medical training. Whereas patient care asks for experience, expertise and close supervision, medical training requires space to practise and the 'invisibility' of medical residents. Yet current reforms in postgraduate medical training point to an increasing emphasis on the measurable visibility of residents. Drawing on an ethnographic study of gynaecology training in The Netherlands, this article demonstrates that in daily clinical routines multiple practices of residents' visibility (visibilities) coexist. The article lists four visibilities: staging residents, negotiating supervision, playing the invisibility game and filming surgical operations. The article shows how attending physicians and medical residents tinker with these visibilities in daily clinical work to provide good care while enacting learning space, highlighting the increasing importance of visualising technologies in clinical work. Moreover, the article contributes to traditional sociological accounts on medical education, shifting the focus from medical education as a social institution to the practices of medical training itself. Such a focus on practice helps to gain an understanding of how the current reform challenges clinicians' educational activities. © 2012 The Authors. Sociology of Health & Illness © 2012 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

Attitudes toward neuroscience education among psychiatry residents and fellows.

PubMed

Fung, Lawrence K; Akil, Mayada; Widge, Alik; Roberts, Laura Weiss; Etkin, Amit

2014-04-01

The purpose of this study is to assess the attitudes of psychiatry trainees toward neuroscience education in psychiatry residency and subsequent training in order to inform neuroscience education approaches in the future. This online survey was designed to capture demographic information, self-assessed neuroscience knowledge, attitudes toward neuroscience education, preferences in learning modalities, and interest in specific neuroscience topics. Volunteers were identified through the American Psychiatric Association, which invited 2,563 psychiatry trainees among their members. Four hundred thirty-six trainees completed the survey. Nearly all agreed that there is a need for more neuroscience education in psychiatry residency training (94%) and that neuroscience education could help destigmatize mental illness (91%). Nearly all (94%) expressed interest in attending a 3-day course on neuroscience. Many neuroscience topics and modes of learning were viewed favorably by participants. Residents in their first 2 years of training expressed attitudes similar to those of more advanced residents and fellows. Some differences were found based on the level of interest in a future academic role. This web-based study demonstrates that psychiatry residents see neuroscience education as important in their training and worthy of greater attention. Our results suggest potential opportunities for advancing neuroscience education.

Burnout in Japanese residents and its associations with temperament and character.

PubMed

Miyoshi, Ryoei; Matsuo, Hisae; Takeda, Ryuichiro; Komatsu, Hiroyuki; Abe, Hiroshi; Ishida, Yasushi

2016-12-01

High risk of burnout in healthcare workers has long been recognized. However, there are no methods to predict vulnerability to burnout. We examined whether temperament and character are associated with burnout and depressive state in residents by using the Temperament and Character Inventory (TCI). The TCI was used for residents at the beginning of clinical training and then the Maslach Burnout Inventory-General Survey (MBI-GS) and the Self-Rating Depression Scale (SDS) were administered at the beginning of clinical training and after four and ten months. Participants were 85 residents who started clinical training after graduating from the University of Miyazaki Hospital in April 2012 and 2013. After ten months, 23.5% of participants were newly identified with burnout using the MBI-GS and 15.3% of participants were newly diagnosed with depressive state using the SDS. We found that residents with high Cooperativeness were significantly more prone to burnout and that residents with high Harm Avoidance and low Self-Directedness were significantly more prone to depressive states. Our results suggest that the TCI can predict not only the risk for future depressive state but also the risk for future burnout. We feel it is important for the resident education system to identify residents with these temperament and character traits and to help high-risk residents avoid burnout and depressive state. Copyright © 2016 Elsevier B.V. All rights reserved.

Grief among Family Members of Nursing Home Residents with Advanced Dementia

PubMed Central

Givens, Jane L.; Prigerson, Holly G.; Kiely, Dan K.; Shaffer, Michele L.; Mitchell, Susan L.

2011-01-01

Objectives To describe pre-loss and post-loss grief symptoms among family members of nursing home (NH) residents with advanced dementia, and to identify predictors of greater post-loss grief symptoms. Design Prospective cohort study. Setting 22 NHs in the greater Boston area. Participants 123 family members of NH residents who died with advanced dementia. Measurements Pre-loss grief was measured at baseline, and post-loss grief was measured 2 and 7 months post-loss using the Prolonged Grief Disorder scale. Independent variables included resident and family member sociodemographic characteristics, resident comfort, acute illness, acute care prior to death, family member depression, and family member understanding of dementia and of resident’s prognosis. Results Levels of pre-loss and post-loss grief were relatively stable from baseline to 7 months post-loss. Feelings of separation and yearning were the most prominent grief symptoms. After multivariable adjustment, greater pre-loss grief and the family member having lived with the resident prior to NH admission were the only factors independently associated with greater post-loss grief 7 months after resident death. Conclusions The pattern of grieving for some family members of NH residents with advanced dementia is prolonged and begins before resident death. Identification of family members at risk for post-loss grief during the pre-loss period may help guide interventions aimed at lessening post-loss grief. PMID:21606897

Lactobacillus johnsonii ameliorates intestinal, extra-intestinal and systemic pro-inflammatory immune responses following murine Campylobacter jejuni infection.

PubMed

Bereswill, Stefan; Ekmekciu, Ira; Escher, Ulrike; Fiebiger, Ulrike; Stingl, Kerstin; Heimesaat, Markus M

2017-05-18

Campylobacter jejuni infections are progressively increasing worldwide. Probiotic treatment might open novel therapeutic or even prophylactic approaches to combat campylobacteriosis. In the present study secondary abiotic mice were generated by broad-spectrum antibiotic treatment and perorally reassociated with a commensal murine Lactobacillus johnsonii strain either 14 days before (i.e. prophylactic regimen) or 7 days after (i.e. therapeutic regimen) peroral C. jejuni strain 81-176 infection. Following peroral reassociation both C. jejuni and L. johnsonii were able to stably colonize the murine intestinal tract. Neither therapeutic nor prophylactic L. johnsonii application, however, could decrease intestinal C. jejuni burdens. Notably, C. jejuni induced colonic apoptosis could be ameliorated by prophylactic L. johnsonii treatment, whereas co-administration of L. johnsonii impacted adaptive (i.e. T and B lymphocytes, regulatory T cells), but not innate (i.e. macrophages and monocytes) immune cell responses in the intestinal tract. Strikingly, C. jejuni induced intestinal, extra-intestinal and systemic secretion of pro-inflammatory mediators (such as IL-6, MCP-1, TNF and nitric oxide) could be alleviated by peroral L. johnsonii challenge. In conclusion, immunomodulatory probiotic species might offer valuable strategies for prophylaxis and/or treatment of C. jejuni induced intestinal, extra-intestinal as well as systemic pro-inflammatory immune responses in vivo.

Examining Critical Thinking Skills in Family Medicine Residents.

PubMed

Ross, David; Schipper, Shirley; Westbury, Chris; Linh Banh, Hoan; Loeffler, Kim; Allan, G Michael; Ross, Shelley

2016-02-01

Our objective was to determine the relationship between critical thinking skills and objective measures of academic success in a family medicine residency program. This prospective observational cohort study was set in a large Canadian family medicine residency program. Intervention was the California Critical Thinking Skills Test (CCTST), administered at three points in residency: upon entry, at mid-point, and at graduation. Results from the CCTST, Canadian Residency Matching Service file, and interview scores were compared to other measures of academic performance (Medical Colleges Admission Test [MCAT] and College of Family Physicians of Canada [CCFP] certification examination results). For participants (n=60), significant positive correlations were found between critical thinking skills and performance on tests of knowledge. For the MCAT, CCTST scores correlated positively with full scores (n=24, r=0.57) as well as with each section score (verbal reasoning: r=0.59; physical sciences: r=0.64; biological sciences: r=0.54). For CCFP examination, CCTST correlated reliably with both sections (n=49, orals: r=0.34; short answer: r=0.47). Additionally, CCTST was a better predictor of performance on the CCFP exam than was the interview score at selection into the residency program (Fisher's r-to-z test, z=2.25). Success on a critical thinking skills exam was found to predict success on family medicine certification examinations. Given that critical thinking skills appear to be stable throughout residency training, including an assessment of critical thinking in the selection process may help identify applicants more likely to be successful on final certification exam.

Story sharing: enhancing nurse aide-resident relationships in long-term care.

PubMed

Heliker, Diane; Nguyen, Hoang Thanh

2010-10-01

National surveys often report nursing home deficiencies related to the preservation of residents' dignity and respectful care. Many nurse aides (NAs), who provide the majority of personal care, are unprepared to engage in empathic and meaningful relationships with residents. This article reports the findings of a pilot mixed method study comparing two interventions, Story Sharing (StS) and Communication Skills, on NA levels of mutuality, empathy, job attitude, and self-efficacy and resident levels of empathy and perceived caring behaviors. A quasi-experimental/interpretive phenomenological design was used. Total Mutuality and subscale (Shared Values, Affective Closeness, Shared Pleasurable Activities, Reciprocity) scores were significantly higher in the StS NA groups only, as were postintervention Empathy scores. Other trends are reported as well. StS is one approach toward helping NH staff and residents understand, respect, and connect with one another. Copyright 2010, SLACK Incorporated.

Prenatal intestinal volvulus: look for cystic fibrosis.

PubMed

Chouikh, Taieb; Mottet, Nicolas; Cabrol, Christelle; Chaussy, Yann

2016-12-21

Intestinal volvulus is a life-threatening emergency requiring prompt surgical management. Prenatal intestinal volvulus is rare, and most are secondary to intestinal atresia, mesenteric defect or without any underlying cause. Cystic fibrosis (CF) is known to cause digestive tract disorders. After birth, 10-15% of newborns with CF may develop intestinal obstruction within a few days of birth because of meconial ileus. 1 This obstruction is a result of dehydrated thickened meconium obstructing the intestinal lumen. We report two cases of fetuses with prenatal diagnosis of segmental volvulus in whom CF was diagnosed. 2016 BMJ Publishing Group Ltd.

Evaluation of intestinal metabolism and absorption using the Ussing chamber system equipped with intestinal tissue from rats and dogs.

PubMed

Miyake, Masateru; Kondo, Satoshi; Koga, Toshihisa; Yoda, Noriaki; Nakazato, Satoru; Emoto, Chie; Mukai, Tadashi; Toguchi, Hajime

2018-01-01

The purpose of this study was to evaluate the intestinal metabolism and absorption in a mini-Ussing chamber equipped with animal intestinal tissues, based on the transport index (TI). TI value was defined as the sum of drug amounts transported to the basal-side component (X corr ) and drug amounts accumulated in the tissue (T corr ), which are normalized by AUC of a drug in the apical compartment, as an index for drug absorption. Midazolam was used as a test compound for the evaluation of intestinal metabolism and absorption. The metabolite formulation of midazolam was observed in both rats and dogs. Ketoconazole inhibited the intestinal metabolism of midazolam in rats and improved its intestinal absorption to a statistically significant extent. Therefore, the mini-Ussing chamber, equipped with animal intestinal tissues, showed potential to use the evaluation of the intestinal metabolism and absorption, including the assessment of species differences. Copyright © 2017. Published by Elsevier B.V.

Applying Expectancy Theory to residency training: proposing opportunities to understand resident motivation and enhance residency training

PubMed Central

Shweiki, Ehyal; Martin, Niels D; Beekley, Alec C; Jenoff, Jay S; Koenig, George J; Kaulback, Kris R; Lindenbaum, Gary A; Patel, Pankaj H; Rosen, Matthew M; Weinstein, Michael S; Zubair, Muhammad H; Cohen, Murray J

2015-01-01

Medical resident education in the United States has been a matter of national priority for decades, exemplified initially through the Liaison Committee for Graduate Medical Education and then superseded by the Accreditation Council for Graduate Medical Education. A recent Special Report in the New England Journal of Medicine, however, has described resident educational programs to date as prescriptive, noting an absence of innovation in education. Current aims of contemporary medical resident education are thus being directed at ensuring quality in learning as well as in patient care. Achievement and work-motivation theories attempt to explain people’s choice, performance, and persistence in tasks. Expectancy Theory as one such theory was reviewed in detail, appearing particularly applicable to surgical residency training. Correlations between Expectancy Theory as a work-motivation theory and residency education were explored. Understanding achievement and work-motivation theories affords an opportunity to gain insight into resident motivation in training. The application of Expectancy Theory in particular provides an innovative perspective into residency education. Afforded are opportunities to promote the development of programmatic methods facilitating surgical resident motivation in education. PMID:25995656

Applying Expectancy Theory to residency training: proposing opportunities to understand resident motivation and enhance residency training.

PubMed

Shweiki, Ehyal; Martin, Niels D; Beekley, Alec C; Jenoff, Jay S; Koenig, George J; Kaulback, Kris R; Lindenbaum, Gary A; Patel, Pankaj H; Rosen, Matthew M; Weinstein, Michael S; Zubair, Muhammad H; Cohen, Murray J

2015-01-01

Medical resident education in the United States has been a matter of national priority for decades, exemplified initially through the Liaison Committee for Graduate Medical Education and then superseded by the Accreditation Council for Graduate Medical Education. A recent Special Report in the New England Journal of Medicine, however, has described resident educational programs to date as prescriptive, noting an absence of innovation in education. Current aims of contemporary medical resident education are thus being directed at ensuring quality in learning as well as in patient care. Achievement and work-motivation theories attempt to explain people's choice, performance, and persistence in tasks. Expectancy Theory as one such theory was reviewed in detail, appearing particularly applicable to surgical residency training. Correlations between Expectancy Theory as a work-motivation theory and residency education were explored. Understanding achievement and work-motivation theories affords an opportunity to gain insight into resident motivation in training. The application of Expectancy Theory in particular provides an innovative perspective into residency education. Afforded are opportunities to promote the development of programmatic methods facilitating surgical resident motivation in education.

Intestinal microbiota in liver disease.

PubMed

Haque, Tanvir R; Barritt, A Sidney

2016-02-01

The intestinal microbiota have emerged as a topic of intense interest in gastroenterology and hepatology. The liver is on the front line as the first filter of nutrients, toxins and bacterial metabolites from the intestines and we are becoming increasingly aware of interactions among the gut, liver and immune system as important mediators of liver health and disease. Manipulating the microbiota with therapeutic intent is a rapidly expanding field. In this review, we will describe what is known about the contribution of intestinal microbiota to liver homeostasis; the role of dysbiosis in the pathogenesis of liver disease including alcoholic and non-alcoholic fatty liver disease, cirrhosis and hepatocellular carcinoma; and the therapeutic manifestations of altering intestinal microbiota via antibiotics, prebiotics, probiotics and fecal microbiota transplantation. Copyright © 2016. Published by Elsevier Ltd.

Identification of isoquercitrin metabolites produced by human intestinal bacteria using UPLC-Q-TOF/MS.

PubMed

Lu, Linling; Qian, Dawei; Yang, Jing; Jiang, Shu; Guo, Jianming; Shang, Er-xin; Duan, Jin-ao

2013-04-01

In this paper, ultraperformance liquid chromatography/quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF/MS) and the MetaboLynx™ software combined with mass defect filtering were applied to identity the metabolites of isoquercitrin using an intestinal mixture of bacteria and 96 isolated strains from human feces. The human incubated samples collected for 72 h in the anaerobic incubator and extracted with ethyl acetate were analyzed by UPLC-Q-TOF/MS within 10 min. The parent compound and five metabolites were identified by eight isolated strains, including Bacillus sp. 17, Veillonella sp. 23 and 32 and Bacteroides sp. 40, 41, 56, 75 and 88 in vitro. The results indicate that quercetin, acetylated isoquercitrin, dehydroxylated isoquercitrin, hydroxylated quercetin and hydroxymethylated quercetin are the major metabolites of isoquercitrin. Furthermore, a possible metabolic pathway for the biotransformation of isoquercitrin was established in intestinal flora. This study will be helpful for understanding the metabolic route of isoquercitrin and the role of different intestinal bacteria in the metabolism of natural compounds. Copyright © 2012 John Wiley & Sons, Ltd.

The extent of intestinal failure-associated liver disease in patients referred for intestinal rehabilitation is associated with increased mortality: an analysis of the pediatric intestinal failure consortium database.

PubMed

Javid, Patrick J; Oron, Assaf P; Duggan, Christopher; Squires, Robert H; Horslen, Simon P

2017-09-05

The advent of regional multidisciplinary intestinal rehabilitation programs has been associated with improved survival in pediatric intestinal failure. Yet, the optimal timing of referral for intestinal rehabilitation remains unknown. We hypothesized that the degree of intestinal failure-associated liver disease (IFALD) at initiation of intestinal rehabilitation would be associated with overall outcome. The multicenter, retrospective Pediatric Intestinal Failure Consortium (PIFCon) database was used to identify all subjects with baseline bilirubin data. Conjugated bilirubin (CBili) was used as a marker for IFALD, and we stratified baseline bilirubin values as CBili<2 mg/dL, CBili 2-4 mg/dL, and CBili>4 mg/dL. The association between baseline CBili and mortality was examined using Cox proportional hazards regression. Of 272 subjects in the database, 191 (70%) children had baseline bilirubin data collected. 38% and 28% of patients had CBili >4 mg/dL and CBili <2 mg/dL, respectively, at baseline. All-cause mortality was 23%. On univariate analysis, mortality was associated with CBili 2-4 mg/dL, CBili >4 mg/dL, prematurity, race, and small bowel atresia. On regression analysis controlling for age, prematurity, and diagnosis, the risk of mortality was increased by 3-fold for baseline CBili 2-4 mg/dL (HR 3.25 [1.07-9.92], p=0.04) and 4-fold for baseline CBili >4 mg/dL (HR 4.24 [1.51-11.92], p=0.006). On secondary analysis, CBili >4 mg/dL at baseline was associated with a lower chance of attaining enteral autonomy. In children with intestinal failure treated at intestinal rehabilitation programs, more advanced IFALD at referral is associated with increased mortality and decreased prospect of attaining enteral autonomy. Early referral of children with intestinal failure to intestinal rehabilitation programs should be strongly encouraged. Treatment Study, Level III. Copyright © 2017 Elsevier Inc. All rights reserved.

A reserve stem cell population in small intestine renders Lgr5-positive cells dispensable

PubMed Central

Tian, Hua; Biehs, Brian; Warming, Soren; Leong, Kevin G.; Rangell, Linda; Klein, Ophir D.; de Sauvage, Frederic J.

2014-01-01

The small intestine epithelium renews every 2 to 5 days, making it one of the most regenerative mammalian tissues. Genetic inducible fate mapping studies have identified two principal epithelial stem cell pools in this tissue. One pool consists of columnar Lgr5-expressing cells that cycle rapidly and are present predominantly at the crypt base1. The other pool consists of Bmi1-expressing cells that largely reside above the crypt base2. However, the relative functions of these two pools and their interrelationship are not understood. Here, we specifically ablated Lgr5-expressing cells using a diphtheria toxin receptor (DTR) gene knocked into the Lgr5 locus. We found that complete loss of the Lgr5-expressing cells did not perturb homeostasis of the epithelium, indicating that other cell types can compensate for elimination of this population. After ablation of Lgr5-expressing cells, progeny production by Bmi1-expressing cells increased, suggesting that Bmi1-expressing stem cells compensate for the loss of Lgr5-expressing cells. Indeed, lineage tracing showed that Bmi1-expressing cells gave rise to Lgr5-expressing cells, pointing to a hierarchy of stem cells in the intestinal epithelium. Our results demonstrate that Lgr5-expressing cells are dispensable for normal intestinal homeostasis. In the absence of these cells, the Bmi1-expressing cells can serve as an alternative stem cell pool, providing the first experimental evidence for the interrelationship between these populations. The Bmi1-expressing stem cells may represent both a reserve stem cell pool in case of injury to the small intestine epithelium and a source for replenishment of the Lgr5-expressing cells under non-pathological conditions. PMID:21927002

Goblet Cells and Mucus Types in the Digestive Intestine and Respiratory Intestine in Bronze Corydoras (Callichthyidae: Teleostei).

PubMed

Leknes, I L

2015-10-01

The structure and histochemical properties of the intestine in bronze corydoras (Corydoras aeneus), a stomach-containing teleost, are described, with emphasis on goblet cells and mucin types. The proximal intestine displayed a normal structure for teleosts, whereas the distal intestine was wide, translucent, thin-walled, richly vascularized and constantly filled with air, suggesting an important respiratory role. Goblet cells were common throughout the entire intestine and displayed a variable, but mainly faint metachromatic colour after toluidine blue. They were moderately coloured by alcian blue at both pH 2.5 and 0.2 and displayed no colour after periodic acid followed by Schiff's solution (PAS), but a distinct purple-brown colour after high iron diamine followed by alcian blue (pH 2.5). Together, these results suggest that the mucin in the intestine goblet cells consists mainly of sulphated proteoglycans. Further, the results from the present lectin and neuraminidase tests suggest that these mucins contain much N-acetylglucoseamines and some N-acetylgalactosamines and sialic acid, but seem to lack glucose and mannose. They also contain some galactose-N-acetylgalactosamines sequences, normally hidden by sialic acid. The distinct brush border and mucus layer on the epithelial cells in the respiratory intestine may indicate some digestive roles, such as absorption of water, ions and simple carbohydrates. As sulphated proteoglycans are tough and attract much water, this mucus may play important roles in the protection against mechanical and chemical damages and in the defence against micro-organisms throughout the entire intestine, but in the respiratory intestine it may impede significantly the oxygen uptake. However, as this part of the intestine usually contains no digesta, but is completely filled with air, frequently renewed by dry air from the atmosphere, and the main function of the mucus may be to protect the respiratory epithelium against a destroying and

The Intestinal Mycobiota in Wild Zebrafish Comprises Mainly Dothideomycetes While Saccharomycetes Predominate in Their Laboratory-Reared Counterparts

PubMed Central

Siriyappagouder, Prabhugouda; Kiron, Viswanath; Lokesh, Jep; Rajeish, Moger; Kopp, Martina; Fernandes, Jorge

2018-01-01

As an integral part of the resident microbial community of fish intestinal tract, the mycobiota is expected to play important roles in health and disease resistance of the host. The composition of the diverse fungal communities, which colonize the intestine, is greatly influenced by the host, their diet and geographic origin. Studies of fungal communities are rare and the majority of previous studies have relied on culture-based methods. In particular, fungal communities in fish are also poorly characterized. The aim of this study was to provide an in-depth overview of the intestinal mycobiota in a model fish species (zebrafish, Danio rerio) and to determine differences in fungal composition between wild and captive specimens. We have profiled the intestinal mycobiota of wild-caught (Sharavati River, India), laboratory-reared (Bodø, Norway) and wild-caught-laboratory-kept (Uttara, India) zebrafish by sequencing the fungal internal transcribed spacer 2 region on the Illumina MiSeq platform. Wild fish were exposed to variable environmental factors, whereas both laboratory groups were kept in controlled conditions. There were also differences in husbandry practices at Bodø and Uttara, particularly diet. Zebrafish from Bodø were reared in the laboratory for over 10 generations, while wild-caught-laboratory-kept fish from Uttara were housed in the laboratory for only 2 months before sample collection. The intestine of zebrafish contained members of more than 15 fungal classes belonging to the phyla Ascomycota, Basidiomycota, and Zygomycota. Fungal species richness and diversity distinguished the wild-caught and laboratory-reared zebrafish communities. Wild-caught zebrafish-associated mycobiota comprised mainly Dothideomycetes in contrast to their Saccharomycetes-dominated laboratory-reared counterparts. The predominant Saccharomycetes in laboratory-reared fish belonged to the saprotrophic guild. Another characteristic feature of laboratory-reared fish was the

The Intestinal Mycobiota in Wild Zebrafish Comprises Mainly Dothideomycetes While Saccharomycetes Predominate in Their Laboratory-Reared Counterparts.

PubMed

Siriyappagouder, Prabhugouda; Kiron, Viswanath; Lokesh, Jep; Rajeish, Moger; Kopp, Martina; Fernandes, Jorge

2018-01-01

As an integral part of the resident microbial community of fish intestinal tract, the mycobiota is expected to play important roles in health and disease resistance of the host. The composition of the diverse fungal communities, which colonize the intestine, is greatly influenced by the host, their diet and geographic origin. Studies of fungal communities are rare and the majority of previous studies have relied on culture-based methods. In particular, fungal communities in fish are also poorly characterized. The aim of this study was to provide an in-depth overview of the intestinal mycobiota in a model fish species (zebrafish, Danio rerio ) and to determine differences in fungal composition between wild and captive specimens. We have profiled the intestinal mycobiota of wild-caught (Sharavati River, India), laboratory-reared (Bodø, Norway) and wild-caught-laboratory-kept (Uttara, India) zebrafish by sequencing the fungal internal transcribed spacer 2 region on the Illumina MiSeq platform. Wild fish were exposed to variable environmental factors, whereas both laboratory groups were kept in controlled conditions. There were also differences in husbandry practices at Bodø and Uttara, particularly diet. Zebrafish from Bodø were reared in the laboratory for over 10 generations, while wild-caught-laboratory-kept fish from Uttara were housed in the laboratory for only 2 months before sample collection. The intestine of zebrafish contained members of more than 15 fungal classes belonging to the phyla Ascomycota, Basidiomycota, and Zygomycota. Fungal species richness and diversity distinguished the wild-caught and laboratory-reared zebrafish communities. Wild-caught zebrafish-associated mycobiota comprised mainly Dothideomycetes in contrast to their Saccharomycetes-dominated laboratory-reared counterparts. The predominant Saccharomycetes in laboratory-reared fish belonged to the saprotrophic guild. Another characteristic feature of laboratory-reared fish was the

Increases in Tolerance within Naturalistic, Self-Help Recovery Homes

PubMed Central

Olson, Brad D.; Jason, Leonard A.; Davidson, Michelle; Ferrari, Joseph R.

2011-01-01

Changes in tolerance toward others (i.e., universality/diversity measure) among 150 participants (93 women, 57 men) discharged from inpatient treatment centers randomly assigned to either a self-help, communal living setting or usual after-care and interviewed every 6 months for a 24 month period was explored. Hierarchical Linear Modeling examined the effect of condition (Therapeutic Communal Living versus Usual Care) and other moderator variables on wave trajectories of tolerance attitudes (i.e., universality/diversity scores). Over time, residents of the communal living recovery model showed significantly greater tolerance trajectories than usual care participants. Results supported the claim that residents of communal living settings unit around super-ordinate goals of overcoming substance abuse problems. Also older compared to younger residents living in a house for 6 or more months experienced the greatest increases in tolerance. Theories regarding these differential increases in tolerance, such as social contact theory and transtheoretical processes of change, are discussed. PMID:19838787

Structured Head and Neck CT Angiography Reporting Reduces Resident Revision Rates.

PubMed

Johnson, Tucker F; Brinjikji, Waleed; Doolittle, Derrick A; Nagelschneider, Alex A; Welch, Brian T; Kotsenas, Amy L

2018-04-12

This resident-driven quality improvement project was undertaken to assess the effectiveness of structured reporting to reduce revision rates for afterhours reports dictated by residents. The first part of the study assessed baseline revision rates for head and neck CT angiography (CTA) examinations dictated by residents during afterhours call. A structured report was subsequently created based on templates on the RSNA informatics reporting website and critical findings that should be assessed for on all CTA examinations. The template was made available to residents through the speech recognition software for all head and neck CTA examinations for a duration of 2 months. Report revision rates were then compared with and without use of the structured template. The structured template was found to reduce revision rates by approximately 50% with 10/41 unstructured reports revised and 2/17 structured reports revised. We believe that structured reporting can help reduce reporting errors, particularly in term of typographical errors, train residents to evaluate complex examinations in a systematic fashion, and assist them in recalling critical findings on these examinations. Copyright © 2018 Elsevier Inc. All rights reserved.

Intestinal organoids: A model of intestinal fibrosis for evaluating anti-fibrotic drugs

PubMed Central

Rodansky, Eva S.; Johnson, Laura A.; Huang, Sha; Spence, Jason R.; Higgins, Peter D. R.

2016-01-01

Background & Aims Intestinal fibrosis is a critical complication of Crohn’s disease (CD). Current in vitro models of intestinal fibrosis cannot model the complex intestinal architecture, while in vivo rodent models do not fully recapitulate human disease and have limited utility for large-scale screening. Here, we exploit recent advances in stem cell derived human intestinal organoids (HIOs) as a new human model of fibrosis in CD. Methods Human pluripotent stem cells were differentiated into HIOs. We identified myofibroblasts, the key effector cells of fibrosis, by immunofluorescence staining for alpha-smooth muscle actin (αSMA), vimentin, and desmin. We examined the fibrogenic response of HIOs by treatment with transforming growth factor beta (TGFβ) in the presence or absence of the anti-fibrotic drug spironolactone. Fibrotic response was assayed by expression of fibrogenic genes (COL1A1 (collagen, type I, alpha 1), ACTA2 (alpha smooth muscle actin), FN1 (fibronectin 1), MYLK (myosin light chain kinase), and MKL1 (megakaryoblastic leukemia (translocation) 1)) and proteins (αSMA). Results Immunofluorescent staining of organoids identified a population of myofibroblasts within the HIO mesenchyme. TGFβ stimulation of HIOs produced a dose-dependent pro-fibrotic response. Spironolactone treatment blocked the fibrogenic response of HIOs to TGFβ. Conclusions HIOs contain myofibroblasts and respond to a pro-fibrotic stimulus in a manner that is consistent with isolated human myofibroblasts. HIOs are a promising model system that might bridge the gap between current in vitro and in vivo models of intestinal fibrosis in IBD. PMID:25828392

Help-Seeking Behavior for Children with Acute Respiratory Infection in Ethiopia: Results from 2011 Ethiopia Demographic and Health Survey.

PubMed

Astale, Tigist; Chenault, Michelene

2015-01-01

Acute respiratory infection is a major contributor to morbidity and mortality among children under five years of age in Ethiopia. While facilities have been implemented to address this problem they are underused due to a lack in help-seeking behavior. This study investigates factors related to the help-seeking behavior of mothers for children with acute respiratory infection using data from the 2011 Ethiopia Demographic and Health Survey. Data on 11,030 children aged 0-59 months obtained through interviewing women aged 15-49 years throughout Ethiopia was available. Descriptive statistics and logistic regression analyses were performed to determine which factors are related to help-seeking behavior for acute respiratory infection. In the two weeks prior to the survey, 773(7%) of the children were reported to have symptoms of acute respiratory infection while treatment was sought for only 209 (27.2%). The odds ratio for acute respiratory infection was 1.6 (95% CI: 1.2-2.0) for rural residence with only 25.2% of these mothers seeking help compared to 46.4% for mothers with an urban residence. Smaller family size, younger mothers' age and having had prenatal care had a statistically significant odds ratio greater than 1 for both urban and rural residences. Highest wealth index had a statistically significant odds ratio greater than 1 for rural residence only, whereas primary education or higher had a statistically significant odds ratio greater than 1 for urban residence. Children from rural areas are more at risk for acute respiratory infection while their mothers are less likely to seek help. Nevertheless, there is also underuse of available services in urban areas. Interventions should target mothers with less education and wealth and older mothers. Expanding prenatal care among these groups would encourage a better use of available facilities and subsequently better care for their children.

Enterocyte fatty acid-binding proteins (FABPs): different functions of liver and intestinal FABPs in the intestine.

PubMed

Gajda, Angela M; Storch, Judith

2015-02-01

Fatty acid-binding proteins (FABP) are highly abundant cytosolic proteins that are expressed in most mammalian tissues. In the intestinal enterocyte, both liver- (LFABP; FABP1) and intestinal FABPs (IFABP; FABP2) are expressed. These proteins display high-affinity binding for long-chain fatty acids (FA) and other hydrophobic ligands; thus, they are believed to be involved with uptake and trafficking of lipids in the intestine. In vitro studies have identified differences in ligand-binding stoichiometry and specificity, and in mechanisms of FA transfer to membranes, and it has been hypothesized that LFABP and IFABP have different functions in the enterocyte. Studies directly comparing LFABP- and IFABP-null mice have revealed markedly different phenotypes, indicating that these proteins indeed have different functions in intestinal lipid metabolism and whole body energy homeostasis. In this review, we discuss the evolving knowledge of the functions of LFABP and IFABP in the intestinal enterocyte. Copyright © 2014 Elsevier Ltd. All rights reserved.

The Cost and Burden of the Residency Match in Emergency Medicine

PubMed Central

Blackshaw, Aaron M.; Watson, Simon C.; Bush, Jeffrey S.

2017-01-01

Introduction To obtain a residency match, medical students entering emergency medicine (EM) must complete away rotations, submit a number of lengthy applications, and travel to multiple programs to interview. The expenses incurred acquiring this residency position are burdensome, but there is little specialty-specific data estimating it. We sought to quantify the actual cost spent by medical students applying to EM residency programs by surveying students as they attended a residency interview. Methods Researchers created a 16-item survey, which asked about the time and monetary costs associated with the entire EM residency application process. Applicants chosen to interview for an EM residency position at our institution were invited to complete the survey during their interview day. Results In total, 66 out of a possible 81 residency applicants (an 81% response rate) completed our survey. The “average applicant” who interviewed at our residency program for the 2015–16 cycle completed 1.6 away, or “audition,” rotations, each costing an average of $1,065 to complete. This “average applicant” applied to 42.8 programs, and then attended 13.7 interviews. The cost of interviewing at our program averaged $342 and in total, an average of $8,312 would be spent in the pursuit of an EM residency. Conclusion Due to multiple factors, the costs of securing an EM residency spot can be expensive. By understanding the components that are driving this trend, we hope that the academic EM community can explore avenues to help curtail these costs. PMID:28116032

Severe Intestinal Inflammation in the Small Intestine of Mice Induced by Controllable Deletion of Claudin-7.

PubMed

Li, Wen-Jing; Xu, Chang; Wang, Kun; Li, Teng-Yan; Wang, Xiao-Nan; Yang, Hui; Xing, Tiaosi; Li, Wen-Xia; Chen, Yan-Hua; Gao, Hong; Ding, Lei

2018-05-01

As a potential tumor suppressor gene, Claudin-7 (Cldn7), which is a component of tight junctions, may play an important role in colorectal cancer occurrence and development. To generate a knockout mouse model of inducible conditional Cldn7 in the intestine and analyze the phenotype of the mice after induction with tamoxifen. We constructed Cldn7-flox transgenic mice and crossed them with Villin-CreERT2 mice. The Cldn7 inducible conditional knockout mice appeared normal and were well developed at birth. We induced Cldn7 gene deletion by injecting different dosages of tamoxifen into the mice and then conducted a further phenotypic analysis. After induction for 5 days in succession at a dose of 200 µl tamoxifen in sunflower oil at 10 mg/ml per mouse every time, the mice appeared dehydrated, had a lower temperature, and displayed inactivity or death. The results of hematoxylin-eosin staining showed that the intestines of the Cldn7 inducible conditional knockout mice had severe intestinal defects that included epithelial cell sloughing, necrosis, inflammation and hyperplasia. Owing to the death of ICKO mice, we adjusted the dose of tamoxifen to a dose of 100 µl in sunflower oil at 10 mg/ml per mouse (aged more than 8 weeks old) every 4 days. And we could induce atypical hyperplasia and adenoma in the intestine. Immunofluorescent staining indicated that the intestinal epithelial structure was destroyed. Electron microscopy experimental analysis indicated that the intercellular gap along the basolateral membrane of Cldn7 inducible conditional knockout mice in the intestine was increased and that contact between the cells and matrix was loosened. We generated a model of intestinal Cldn7 inducible conditional knockout mice. Intestinal Cldn7 deletion induced by tamoxifen initiated inflammation and hyperplasia in mice.

Use of a Self-Reflection Tool to Enhance Resident Learning on an Adolescent Medicine Rotation.

PubMed

Greenberg, Katherine Blumoff; Baldwin, Constance

2016-08-01

Adolescent Medicine (AM) educators in pediatric residency programs are seeking new ways to engage learners in adolescent health. This mixed-methods study presents a novel self-reflection tool and addresses whether self-reflection enhanced residents' perception of the value of an adolescent rotation, in particular, its relevance to their future practice. The self-reflection tool included 17 Likert scale items on residents' comfort with the essential tasks of adolescent care and open-ended questions that promoted self-reflection and goal setting. Semi-structured, postrotation interviews encouraged residents to discuss their experiences. Likert scale data were analyzed using descriptive statistics, and interview notes and written comments on the self-reflection tool were combined for qualitative data analysis. Residents' pre-to post-self-evaluations showed statistically significant increases in comfort with most of the adolescent health care tasks. Four major themes emerged from our qualitative analysis: (1) the value of observing skilled attendings as role models; (2) the comfort gained through broad and frequent adolescent care experiences; (3) the career relevance of AM; and (4) the ability to set personally meaningful goals for the rotation. Residents used the self-reflection tool to mindfully set goals and found their AM education valuable and relevant to their future careers. Our tool helped make explicit to residents the norms, values, and beliefs of the hidden curriculum applied to the care of adolescents and helped them to improve the self-assessed quality of their rapport and communications with adolescents. We conclude that a structured self-reflection exercise can enhance residents' experiences on an AM rotation. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Kaiso overexpression promotes intestinal inflammation and potentiates intestinal tumorigenesis in Apc(Min/+) mice.

PubMed

Pierre, Christina C; Longo, Joseph; Mavor, Meaghan; Milosavljevic, Snezana B; Chaudhary, Roopali; Gilbreath, Ebony; Yates, Clayton; Daniel, Juliet M

2015-09-01

Constitutive Wnt/β-catenin signaling is a key contributor to colorectal cancer (CRC). Although inactivation of the tumor suppressor adenomatous polyposis coli (APC) is recognized as an early event in CRC development, it is the accumulation of multiple subsequent oncogenic insults facilitates malignant transformation. One potential contributor to colorectal carcinogenesis is the POZ-ZF transcription factor Kaiso, whose depletion extends lifespan and delays polyp onset in the widely used Apc(Min/+) mouse model of intestinal cancer. These findings suggested that Kaiso potentiates intestinal tumorigenesis, but this was paradoxical as Kaiso was previously implicated as a negative regulator of Wnt/β-catenin signaling. To resolve Kaiso's role in intestinal tumorigenesis and canonical Wnt signaling, we generated a transgenic mouse model (Kaiso(Tg/+)) expressing an intestinal-specific myc-tagged Kaiso transgene. We then mated Kaiso(Tg/+) and Apc(Min/+) mice to generate Kaiso(Tg/+):Apc(Min/+) mice for further characterization. Kaiso(Tg/+):Apc(Min/+) mice exhibited reduced lifespan and increased polyp multiplicity compared to Apc(Min/+) mice. Consistent with this murine phenotype, we found increased Kaiso expression in human CRC tissue, supporting a role for Kaiso in human CRC. Interestingly, Wnt target gene expression was increased in Kaiso(Tg/+):Apc(Min/+) mice, suggesting that Kaiso's function as a negative regulator of canonical Wnt signaling, as seen in Xenopus, is not maintained in this context. Notably, Kaiso(Tg/+):Apc(Min/+) mice exhibited increased inflammation and activation of NFκB signaling compared to their Apc(Min/+) counterparts. This phenotype was consistent with our previous report that Kaiso(Tg/+) mice exhibit chronic intestinal inflammation. Together our findings highlight a role for Kaiso in promoting Wnt signaling, inflammation and tumorigenesis in the mammalian intestine. Copyright © 2015 Elsevier B.V. All rights reserved.

The metabolic profile of acteoside produced by human or rat intestinal bacteria or intestinal enzyme in vitro employed UPLC-Q-TOF-MS.

PubMed

Cui, Qingling; Pan, Yingni; Xu, Xiaotong; Zhang, Wenjie; Wu, Xiao; Qu, Shouhe; Liu, Xiaoqiu

2016-03-01

Acteoside, the main and representative phenylethanoid glycosides of Herba Cistanches, possesses wide bioactivities but low oral bioavailability. It may serve as the prodrug and be converted into the active forms in gastrointestinal tract, which mainly occurred in intestinal tract composed of intestinal bacteria and intestinal enzyme. Intestinal bacteria, a new drug target, take a significant role on exerting pharmacological effects of drugs by oral administration. In this paper, acteoside was incubated with human or rat intestinal bacteria or rat intestinal enzyme for 36 h to seek metabolites responsible for pharmacodynamics. The samples were analyzed by ultra-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry. Besides the parent compound, 14 metabolites were detected and identified based on their retention times and fragmentation patterns in their MS spectra including 8 degradation metabolites, 2 isomers in intestinal bacteria and intestinal enzyme samples and 4 parent metabolites only found in intestinal enzymes. The metabolic pathway of acteoside was thus proposed. Identification of these metabolites of acteoside by the intestinal bacteria or intestinal enzyme gave an insight to clarify pharmacological mechanism of traditional Chinese medicines and identify the real active molecules. Copyright © 2015 Elsevier B.V. All rights reserved.

What opportunities are available for resident involvement in national orthopedic and subspecialty societies?

PubMed

Dy, Christopher J; Cross, Michael B; Osbahr, Daryl C; Parks, Michael L; Green, Daniel W

2011-10-05

As physician involvement in health policy grows, there will be an increasing need for future leaders in orthopedics. Interested orthopedic residents may be unaware of opportunities for leadership involvement in professional and subspecialty organizations. This article investigates whether national and subspecialty organizations offer membership to residents, allow residents to participate in committees, and provide opportunities for scholarly activity and mentorship. The authors surveyed 20 national orthopedic professional and subspecialty societies to evaluate the availability and cost of resident membership, meeting attendance and participation, research funding, committee membership, and mentorship opportunities. Each society's Web site was reviewed, and societies were contacted by phone if further inquiry was needed. Of the 20 orthopedic societies surveyed, 11 allowed resident membership. Five of 20 societies allowed residents to serve on committees, with a total of 14 total positions for residents. Four organizations provided formalized mentorship programs to residents. Although opportunities for resident involvement in subspecialty and professional societies are available in the majority of groups surveyed, the Orthopaedic Trauma Association and American Society for Surgery of the Hand provided the most comprehensive collection of opportunities. Residents should also pursue involvement in other organizations that may be more readily accessible, such as local, state, and regional orthopedic and medical societies. Increased resident participation in these organizations may help in increasing the 14 nationally available committee positions for orthopedic residents. Our orthopedic profession and societies should encourage motivated residents to pursue involvement and leadership at the national level. Copyright 2011, SLACK Incorporated.

A mathematical model of intestinal oedema formation.

PubMed

Young, Jennifer; Rivière, Béatrice; Cox, Charles S; Uray, Karen

2014-03-01

Intestinal oedema is a medical condition referring to the build-up of excess fluid in the interstitial spaces of the intestinal wall tissue. Intestinal oedema is known to produce a decrease in intestinal transit caused by a decrease in smooth muscle contractility, which can lead to numerous medical problems for the patient. Interstitial volume regulation has thus far been modelled with ordinary differential equations, or with a partial differential equation system where volume changes depend only on the current pressure and not on updated tissue stress. In this work, we present a computational, partial differential equation model of intestinal oedema formation that overcomes the limitations of past work to present a comprehensive model of the phenomenon. This model includes mass and momentum balance equations which give a time evolution of the interstitial pressure, intestinal volume changes and stress. The model also accounts for the spatially varying mechanical properties of the intestinal tissue and the inhomogeneous distribution of fluid-leaking capillaries that create oedema. The intestinal wall is modelled as a multi-layered, deforming, poroelastic medium, and the system of equations is solved using a discontinuous Galerkin method. To validate the model, simulation results are compared with results from four experimental scenarios. A sensitivity analysis is also provided. The model is able to capture the final submucosal interstitial pressure and total fluid volume change for all four experimental cases, and provide further insight into the distribution of these quantities across the intestinal wall.

Remediation plans in family medicine residency

PubMed Central

Audétat, Marie-Claude; Voirol, Christian; Béland, Normand; Fernandez, Nicolas; Sanche, Gilbert

2015-01-01

Abstract Objective To assess use of the remediation instrument that has been implemented in training sites at the University of Montreal in Quebec to support faculty in diagnosing and remediating resident academic difficulties, to examine whether and how this particular remediation instrument improves the remediation process, and to determine its effects on the residents’ subsequent rotation assessments. Design A multimethods approach in which data were collected from different sources: remediation plans developed by faculty, program statistics for the corresponding academic years, and students’ academic records and rotation assessment results. Setting Family medicine residency program at the University of Montreal. Participants Family medicine residents in academic difficulty. Main outcome measures Assessment of the content, process, and quality of remediation plans, and students’ academic and rotation assessment results (successful, below expectations, or failure) both before and after the remediation period. Results The framework that was developed for assessing remediation plans was used to analyze 23 plans produced by 10 teaching sites for 21 residents. All plans documented cognitive problems and implemented numerous remediation measures. Although only 48% of the plans were of good quality, implementation of a remediation plan was positively associated with the resident’s success in rotations following the remediation period. Conclusion The use of remediation plans is well embedded in training sites at the University of Montreal. The residents’ difficulties were mainly cognitive in nature, but this generally related to deficits in clinical reasoning rather than knowledge gaps. The reflection and analysis required to produce a remediation plan helps to correct many academic difficulties and normalize the academic career of most residents in difficulty. Further effort is still needed to improve the quality of plans and to support teachers.

TH-E-201-02: Hands-On Physics Teaching of Residents in Diagnostic Radiology

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhang, J.

The ABR Core Examination stresses integrating physics into real-world clinical practice and, accordingly, has shifted its focus from passive recall of facts to active application of physics principles. Physics education of radiology residents poses a challenge. The traditional method of didactic lectures alone is insufficient, yet it is difficult to incorporate physics teaching consistently into clinical rotations due to time constraints. Faced with this challenge, diagnostic medical physicists who teach radiology residents, have been thinking about how to adapt their teaching to the new paradigm, what to teach and meet expectation of the radiology resident and the radiology residency program.more » The proposed lecture attempts to discuss above questions. Newly developed diagnostic radiology residents physics curriculum by the AAPM Imaging Physics Curricula Subcommittee will be reviewed. Initial experience on hands-on physics teaching will be discussed. Radiology resident who will have taken the BAR Core Examination will share the expectation of physics teaching from a resident perspective. The lecture will help develop robust educational approaches to prepare radiology residents for safer and more effective lifelong practice. Learning Objectives: Learn updated physics requirements for radiology residents Pursue effective approaches to teach physics to radiology residents Learn expectation of physics teaching from resident perspective J. Zhang, This topic is partially supported by RSNA Education Scholar Grant.« less

Intestinal Mononuclear Phagocytes in Health and Disease.

PubMed

Sanders, Theodore J; Yrlid, Ulf; Maloy, Kevin J

2017-01-01

The intestine is the tissue of the body with the highest constitutive exposure to foreign antigen and is also a common entry portal for many local and systemic pathogens. Therefore, the local immune system has the unenviable task of balancing efficient responses to dangerous pathogens with tolerance toward beneficial microbiota and food antigens. As in most tissues, the decision between tolerance and immunity is critically governed by the activity of local myeloid cells. However, the unique challenges posed by the intestinal environment have necessitated the development of several specialized mononuclear phagocyte populations with distinct phenotypic and functional characteristics that have vital roles in maintaining barrier function and immune homeostasis in the intestine. Intestinal mononuclear phagocyte populations, comprising dendritic cells and macrophages, are crucial for raising appropriate active immune responses against ingested pathogens. Recent technical advances, including microsurgical approaches allowing collection of cells migrating in intestinal lymph, intravital microscopy, and novel gene-targeting approaches, have led to clearer distinctions between mononuclear phagocyte populations in intestinal tissue. In this review, we present an overview of the various subpopulations of intestinal mononuclear phagocytes and discuss their phenotypic and functional characteristics. We also outline their roles in host protection from infection and their regulatory functions in maintaining immune tolerance toward beneficial intestinal antigens.